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We Need to Change the Terms of the Debate on Trans Kids

Every night, when I walk my dog, several strangers, similarly tethered, will ask me the same two questions: “Boy or girl?” and “How old?” The pragmatic meaning of these questions escapes me. The answers do not inform the interactions between our dogs, nor do they tell a story. Wouldn’t it be more interesting to learn whether the dog was a longtime family member or a pandemic puppy, whether it lived with other pets, how much exercise it got or desired, how it tolerated last summer’s orgy of fireworks, or to learn at least the dog’s name? These are the questions I usually ask other dog owners as our pets sniff each other, but in response I am still asked—hundreds of times a year—about my dog’s age and gender. These categories, it seems, are so central to the way we organize the world around us that we apply them to everything, including random dogs in the night.

No wonder, then, that attempts to subvert these two categories make people uncomfortable and, often, scared and angry. This happens when children act with particular independence; when people challenge the norms of gender; and, especially, when both of these things happen at once, as in the case of trans children. In December, the British High Court of Justice ruled on the question of whether young people under the age of eighteen are capable of giving informed consent to treatments that forestall puberty. Such treatments can be prescribed to children given a diagnosis of gender dysphoria, both to alleviate discomfort that can stem from the physical changes brought on by puberty and to pave the way for later medical gender transition. The court ruled that children under sixteen cannot consent to such treatment because they are unable to grasp its long-term consequences, and cast doubt on the ability of young people between the ages of sixteen and eighteen to give informed consent. The decision effectively bars British children and adolescents from transitioning medically.

British media coverage of the High Court’s decision was generally positive. “Other countries should learn from a transgender verdict in England” the Economist wrote . “The court was correct to curb a disturbing trend,” the Observer wrote . Later in the month, the BBC’s media editor, Amol Rajan, published his list of the five best essays of the year, among them J. K. Rowling’s piece explaining her position “on sex and gender issues.” Rowling, who presents herself as a defender of bathrooms, dressing rooms, and other “single-sex spaces” against trans women, wrote that she was “concerned about the huge explosion in young women wishing to transition and also about the increasing numbers who seem to be detransitioning.” She cited the controversial hypothesis that some adolescent transitions may stem from a kind of social contagion. Had transition been an option during her own adolescence, Rowling wrote, she might have chosen it as a way to deal with her own mental-health challenges: “The allure of escaping womanhood would have been huge.”

In the United States, this line of argument has been advanced by Abigail Shrier, a writer for the Wall Street Journal who published a book last year titled “ Irreversible Damage: The Transgender Craze Seducing Our Daughters .” The cover art is a drawing of a prepubescent girl with a giant round cutout where her abdomen should be. The book is currently ranked “#1 Bestseller in Transgender Studies” on Amazon. Bills that would ban trans care for young people have already been prefiled for this year’s legislative sessions in Alabama, Texas, and Missouri; last year, a similar bill was defeated in South Dakota, thanks to opposition from the pharmaceutical industry. When such bills contain language explaining their rationale, they make similar arguments to those of Rowling, Shrier, and the British High Court: that the effects of trans care are irreversible and that many people who want to transition when they are adolescents will ultimately choose to identify with the gender they were assigned at birth.

The state bills tend to lump all kinds of trans care—puberty blockers, cross-sex hormones, and surgeries—together. As a narrative, this is not unreasonable: the vast majority of people who receive puberty blockers do go on to take cross-sex hormones, and many choose surgery. But the short- and long-term effects of the medical interventions are markedly different. Agonists of gonadotropin-releasing hormone, originally developed to treat prostate cancer and endometriosis in adults, can have the effect of preventing puberty-related changes: genital growth, breasts, body and facial hair, and voice changes. Estrogen promotes breast growth, and testosterone will likely lead to a lower voice and more body and facial hair; both kinds of hormones affect fat and muscle distribution. The effects of hormones are not as predictable—and the line between reversible and irreversible effects of hormone treatments isn’t as clear—as their opponents seem to think, but a person whose puberty is effectively prevented and who later receives cross-sex hormones is unlikely to preserve their fertility. Some European researchers are experimenting with reserving gonad tissue that may be used to create biological progeny later (similar efforts are made with children undergoing cancer treatment that is likely to render them infertile). Natal males and females who transition during adolescence forfeit their fertility equally, but Rowling, Shirer, and other opponents of pediatric trans care seem particularly concerned with people they see as girls clamoring to escape womanhood. (The lead plaintiff in the British case, Keira Bell, who was assigned female at birth, began taking puberty blockers at sixteen and testosterone at seventeen and had a double mastectomy at twenty. Bell later transitioned back to being female.)

“Women and children are always mentioned in the same breath,” the visionary feminist activist Shulamith Firestone observed in the book “ The Dialectic of Sex: The Case for Feminist Revolution ,” from 1970. “I submit . . . that the nature of this bond is no more than shared oppression. And that moreover this oppression is intertwined and mutually reinforcing in such complex ways that we will be unable to speak of the liberation of women without also discussing the liberation of children, and vice versa.” Firestone noted that women and children were inextricably linked not only by the women’s duty of childbearing and child rearing but by the obligation, for both groups, to maintain innocence, fragility, immaturity, and dependence on others. She saw the path to liberation in divorcing the reproductive function from women’s biology, and in abolishing childhood. One might argue that young people who seek trans care are pursuing both of these projects, and that is why they inspire such panicked opposition.

Yet the arguments in favor of trans care for young people are usually not so much liberationist as they are determinist. Advocates generally claim that trans children are innately, immutably different from cis children and that access to medical transition is essential for staving off depression and even suicide. “The fear that puberty per se can be a threat to life for transgender children permeates pediatric trans care,” Sahar Sadjadi wrote in an essay in Transgender Studies Quarterly last year. (Sadjadi is a medical anthropologist who has studied clinical practices for transitioning and other non-gender-conforming children for a decade.) This type of advocacy, she argues, builds on two long-standing tendencies: the habit of thinking of gender transition as primarily a medical process, and the habit of grounding L.G.B.T. civil-rights claims in “born this way” rhetoric. These habits make for a compelling, easily digestible argument: transness is an immutable characteristic, and denying young people access to medical transition can be tantamount to killing them. This argument is grounded in the lived experience of some advocates, whose own medical transition relieved extreme anguish. But an argument rooted in despair cannot and should not represent all young trans people.

When we are not talking about children and adolescents, trans people talk about a much broader range of options than medical transition—a spectrum of gender expression more varied than the linear path of puberty blockers followed by cross-sex hormones. Some adult trans people consider themselves binary, and some don’t; some use hormones and have surgeries, some choose one or the other, some try different approaches, and some eschew medical interventions altogether. Medical intervention requires a diagnosis of gender dysphoria, even if the person is paying for surgery and hormones out of pocket. In general, though, adults are not required to prove that they have always felt like they were in the wrong body (although some have).

If we hold to the premise that transness is an immutable, inborn trait, it follows that every young person who chooses to detransition will undermine the case any other young person may have for seeking trans care. “The main debate has become whether these young people will ‘persevere,’ ” Sadjadi told me by Zoom from Montreal, where she is on the faculty at McGill University’s Department of Social Studies of Medicine. “I think this is the wrong question. Gender changes with age. The gender of a fifty-year-old woman is not the same as of a five-year-old girl. Nothing terrible happens if a person transitions again, which is how I think we should think about it.”

The British High Court’s decision makes a point that appears compelling and compassionate. A child, the panel decided, cannot fully comprehend the meaning of infertility and possible loss of sexual function that come with transitioning at a young age. (One concern is that puberty blockers prevent genital growth, making gender-affirming bottom surgery more complicated.) But this argument rests not only on a narrow definition of sexual pleasure but on an impossible ideal of comprehension: we can never fully imagine loss, especially the loss of something we’ve never had. Keira Bell testified, “It is only until recently that I have started to think about having children and if that is ever a possibility, I have to live with the fact that I will not be able to breastfeed my children. I still do not believe that I have fully processed the surgical procedure that I had to remove my breasts and how major it really was.” As heartbreaking as that admission is, all available data indicate that such regrets are exceedingly rare. That one person’s testimony convinced the court to make a decision that will affect untold thousands tells us more about the pull that human reproduction has on the imagination than it does about gender transition.

“People change their minds about all kinds of decisions,” Sadjadi added. Hers is not an argument against thinking of transition as a serious, consequential decision, but rather an argument for viewing gender transition as one of the many important choices some people face. People—including young people, acting legally, with their parents’ support—choose to have babies, move continents, subject themselves to extreme physical risk by engaging in certain sports, make what often amounts to commitments to lifelong medical intervention with S.S.R.I.s for depression or stimulants for attention deficit hyperactivity disorder, join the R.O.T.C. or the National Guard. None of these decisions is just like the decision to transition. But are they really so much lighter, so much less consequential, that the possibility of one person reversing course shouldn’t prevent others from making the same choices?

In her 1970 book, Firestone discussed the arbitrary historical boundaries of childhood. In other eras, boys would be expected to abandon toys and take up adult vocations at the age of seven; girls were historically married off as soon as they went through puberty. Firestone’s point was that childhood was a relatively new category, and an unstable one. Our own ideas of maturity are no less arbitrary than our ancestors’. We know that a fifteen-year-old is probably better equipped to make life decisions than is a nine-year-old, who is still vastly more experienced and informed than a four-year-old. But for the purposes of the law, we lump them in the same category. An eighteen-year-old, on the other hand, is deemed capable of making the full range of life choices—except for whether to ingest alcohol. There is little doubt, however, that the experience, wisdom, and skill for assessing risk and making decisions continue to accumulate well past middle age. If you think about it, a fifty-year-old who has experienced life in a particular gender is in a much better position to make a decision about transition than is a twenty-year-old. But at that point, it’s too late to decide to be a young person in the other gender, and this, too, is irreversible. I began my own transition at fifty, long after experiencing the misery of pregnancy and the incomparable joy of breastfeeding. I have no regrets. Had I had the option of transitioning as a teen-ager, I would have chosen to do so—and I am almost certain that I would have had no regrets then, either, because I would have had a different life.

Sadjadi, who was a physician before she became an anthropologist, has written that puberty blockers are not as medically inconsequential as they are often portrayed. Although they appear to have no long-term physical effects if they are used for a short time (a year or less), some studies suggest that they can have long-term detrimental effects for the musculoskeletal system if they are used for three or four years. (Long-term data comes from the use of puberty blockers to forestall what is deemed “precocious” puberty, occurring in children under the age of nine.) The manufacturer of Lupron, the drug most commonly used as a puberty blocker, warns of depression as a possible side effect. Sadjadi suggested freeing gender transition in young people from the assumption that they will necessarily take puberty blockers. For some kids, she said, it may be worth considering social transition as the first or even only step. Social transition is often conspicuously absent from the menu offered to adolescents. For others, cross-sex hormones may be preferable to puberty blockers, which are supposed to “buy time” before a child is deemed old enough to make the commitment to transitioning. There is not enough data to say whether and when these may be the better care options.

To be able to talk about a range of transition options, at different times in life, we would need to change the terms of the debate. We would need to view both age and gender on a continuum, not as binary states. None of us has ever been as innocent and ignorant as the children of our imagination, and none of us will ever be as wise and competent as the adults we make ourselves out to be. What if we saw ourselves as always changing, always uncertain, but always capable of making choices? What if we accepted that some losses are desirable and some are regrettable, and that we can’t always know the difference? What if we knew that we are always changing not only as individuals but as societies, and the categories we use to sort ourselves mutate faster than we realize? Then maybe we could have a real conversation about trans care for young people.

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Transgender identities: a series of invited essays

As discussion about gender self-identification becomes heated, the economist seeks to uphold the liberal value of open debate.

By H.J. | LONDON

This is the introduction to a two-week, ten-part series of essays on transgender identities. Click here for the essays .

FROM the transgender bathroom debate in America to the argument in Britain over who can stand for election on women-only shortlists, a row about transgender identities is generating more heat than light. On one hand are some transgender people and activists, who advocate for “gender self-identification”: the belief that the world should take at face value a person’s declaration of their own gender identity. On the other are people who assert the primacy of biological sex; who fear the erosion of protections for women, including from male violence; or who see gender as a pernicious class system that maintains male supremacy and would like it done away entirely.

The row pits one historically oppressed group against another. It strikes at some very modern dilemmas: the usefulness of identity politics; the accommodations that should be made for small subgroups; how to work towards inclusion without triggering a backlash.

Further heightening tensions, many countries are considering changing the way someone can legally change gender from a process mediated by medical professionals to one of gender self-identification, and a few have already done so. On July 3rd Britain launched a public consultation on this issue: under government proposals, a simple statutory declaration would suffice to change your legal gender, and enable you to change the sex stated on your birth certificate and other official records.

To coincide with the consultation, The Economist is hosting a series of essays from a range of people with interesting and varied viewpoints, insights and arguments on transgender identities. The series will run over two weeks, with two or three essays published each day in the first week, and further comments and discussion between our participants published next week. On July 13th I will wrap up the event, drawing out the points that most struck me from the essays, and from readers’ comments.

This online event is part of The Economist ’s Open Future project, which aims to remake the case for liberalism today. One of the liberal values we seek to uphold is open debate. When it comes to transgender issues, and gender self-identification in particular, positions have become entrenched. Debate has become polarised, toxic and unilluminating. We hope our event will help to change that.

In the interests of fostering open debate we have set ground rules, both for essays and reader comments: use the pronouns people want you to use, and avoid all slurs, including TERF (trans-exclusionary radical feminist), which may have started as a descriptive term but is now used to try to silence a vast swathe of opinions on trans issues, and sometimes to incite violence against women. Comments will be open but closely moderated.

We are grateful to our contributors, who have agreed with grace and good humour to step onto this contested ground. We hope they will all find the fortnight interesting and perhaps even illuminating. We have enormously enjoyed reading their thoughts, and have already learned a great deal.

Essays published so far:

Vic Valentine: “ Self-declaration would bring Britain into line with international best practice ”

Debbie Hayton: “ Gender identity needs to be based on objective evidence rather than feelings ”

Kristina Harrison: “ A system of gender self-identification would put women at risk ”

Charlie Kiss: “ The idea that trans men are “lesbians in denial” is demeaning and wrong ”

Pippa Fleming: “ The gender-identity movement undermines lesbians ”

Sarah Ditum: “ Trans rights should not come at the cost of women’s fragile gains ”

Emily Brothers: “ Making transitioning simpler would not usurp the rights of women ”

James Kirkup: “ I am neither trans nor a woman. Can I write about the issues they face? ”

Kathleen Stock: “ Changing the concept of “woman” will cause unintended harms ”

Adam Smith: “ The struggle for trans rights has parallels to that for gay rights ”

Adam Smith: “ The online debate over transgender identity needs more speech, not less ”

Debbie Hayton: “ Society needs to dismantle sexism before revising legal definitions of sex ”

Sarah Dittum: “ Transgender issues are not yet a schism between conservatives and liberals in Britain ”

Dig deeper:

“ Making sense of the culture war over transgender identity ,” The Economist , November 16th 2017.

“ Children are victims in the latest identity-driven culture war ,” The Economist , Leader, November 16th 2017

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All the Arguments You Need: To Prove It’s Fair for Trans, Intersex Athletes to Compete in Consistence With Their Gender Identity

Bodies and gender identities aren’t binary, so why are sporting competitions?

Nowhere is the struggle between maintaining the traditional status quo of the gender binary, and moving forward toward greater inclusivity, more pronounced than in competitive sports, due to the differences in male and female physiology. But, there is enough science and data out there to suggest these differences aren’t nearly as stark as we’ve been led to believe — which means any argument against allowing trans and intersex people and people with differences in sex development (DSD) to compete against ciswomen is queerphobic at best. Here are all the arguments you need to fight for greater gender inclusivity in sport.

“Biological males have physical advantages over women such as more stamina, larger bones, and more muscle, so it’s unfair for trans women to compete with ciswomen.”

The science on what women’s bodies can do is flimsy at best. But consider what the female body can do better than a male body: “Women’s bodies have a lower center of gravity and therefore better balance; they tend to be more flexible, and their bodies more efficiently convert calories into energy giving them greater endurance,” Liesl Goeker writes for The Swaddle , while arguing for equal pay in sports. This gives women the upper hand in ultra-endurance running and gymnastics — just as male bodies have the upper hand when it comes to sports such as the shotput and 100m sprint that require speed and brute strength. But zero trans women who are gymnasts are complaining about the advantage cis women have, or saying they want to compete in the men’s category for endurance running or gymnastics — because they just want to participate in the sports category congruent with their gender identity.

Besides, sports isn’t ‘fair.’ It never was. Genetics isn’t either. Many elite athletes are genetically blessed in a way the average person isn’t. Basketball players have the advantage of height, and Michel Phelps’s very peculiar anatomy gives him the upper handin swimming. Privilege isn’t fair either — athletes of color are at a disadvantage when it comes to exposure, opportunities, and resources to even begin pursuing sports competitively, compared to Caucasian athletes. So, what is this “level playing field” argument but a myth spun by those allowed to play and win in the field, to maintain the status quo?

Related on The Swaddle:

New Report Outlines Scale of Homophobia, Transphobia in Sport

“Biological males have the advantage of testosterone that enhances performance so it’s unfair for trans women to compete with ciswomen.”

The science on physiological advantages male athletes have over female athletes is in a nascent stage. It’s important to preface this argument by pointing out that very little research and conversation is around, say, the advantages of estrogen (the hormone responsible for many physical characteristics of a typical female) or prolactin (the breastfeeding hormone) on athletic ability. The obsession is entirely with testosterone (T) — the hormone responsible for many glorified physical characteristics of a typical male — and the absurd question of at what level of testosterone does a female athlete become too good to be a woman.

For every credible study and statement out there that proves greater testosterone is linked to greater athletic ability in men and women, there are equally credible studies that prove testosterone is just one of the many factors that affect sporting ability — sometimes even negatively. Take the International Association for Athletics Federation’s data on elite women athletes. Its initial analysis of two world championships showed that women with higher T levels performed better in only five out of 21 events.

After an independent group of researchers took an issue with the research methodology to reach even this finding, the sports body was forced to issue a correction. In the corrected results, in three of 11 running events, the group with the lowest levels of T did better. Across all events, the association between T and performance was the strongest (and the most surprising) in the 100m sprint: athletes with lower T ran 5.4% faster than those with the highest levels of T. The independent group of researchers who objected to the results earlier concluded it’s “impossible” to discern the real relationship, if any, between T and performance. Clearly, though, neither this study nor the broader sports science literature supports the IAAF’s claim that targeted trans, intersex athletes  “have the same advantages over [other] women as men do over women.”

Then there’s the stuff outside of the binary that science is nowhere close to explaining clearly, like Chand’s and Semenya’s hyperandrogenism (a medical condition where a typical female body produces higher testosterone than usual). Or, as Faryal Mirza, a clinical endocrinologist at the University of Connecticut Medical Center, tells Scientific American , sometimes high T simply means that a person isn’t very efficient at using T: the body is producing more precisely to arrive at “typical” function of someone producing T in the “typical range.”

IAAF’s Caster Semenya Decision Arbitrarily Dictates What Is Female

A review of 31 national and international transgender sporting policies, including those of the International Olympic Committee, the Football Association, Rugby Football Union and the Lawn Tennis Association by researchers at the Scool of Sports Exercise and Health Sciences, Loughborough University concluded : “After considering the very limited and indirect physiological research that has explored athletic advantage in transgender people, we concluded that the majority of these policies were unfairly discriminating against transgender people, especially transgender females” by overinterpreting the “unsubstantiated belief” that testosterone improves athletic performance.

Thousands of trans athletes have been competing at national and international competitions who you just don’t hear about simply because they don’t all win or qualify for the Olympics even with all their apparent unfair advantages. This also proves the non-cisgender athletes who do go ahead and win medals owe their success more to their training, skill, perseverance, resilience, and a host of other reasons apart from their gender or sex, and especially from the myth of testosterone.

“Letting trans and intersex women compete in women’s sports will lead to many male athletes pretending to be women just so they can easily win.”

Yikes. Are we really suggesting there are numerous male athletes who will declare they identify as women, go through exhausting transition processes such as hormone replacement, gather the required medical and psychological proof of their fake gender dysmorphia (prolonged distress caused a mismatch between their biological sex and gender identity), go through their entire lives living under the pretense of being female, all while facing prejudice that trans people face on a daily basis — only for a few gold medals and some cash? Notwithstanding the paranoia (looking at you Martina Navratilova ), this argument is the literal definition of transphobia . This idea — that we should ban all innocent and real trans and intersex women based solely on the fantastic hypothetical of the fraudulent cis man — has roots in an irrational fear of the other (in this case, non-cisgender people) based on prejudice or ignorance.

Laws and rules can always be misused, irrespective of gender. But, we can’t deny people’s rights simply because a few could, in theory, game the system. Look at it this way: are some people falsely framed for murder? Yes. Does that mean we don’t have any rules to punish the crime? Of course not.

This debate doesn’t even have to be esoteric; there is actual data to prove male athletes aren’t queuing up to declare a new gender identity. In 2003, the International Olympic Committee adopted the Stockholm Consensus (SC) allowing the inclusion of trans athletes who had undergone sex reassignment, making it possible for trans athletes to compete in the Olympics from 2004. The IOC modified these guidelines in 2015 to put a cap on testosterone levels for trans womenathletes. And yet, despite the fact that more than 50,000 athletes have participated in the Olympics since 2004, no trans athlete has ever been a part of the Olympics until now, real or fake. So, clearly including trans athletes in sports won’t make the sky fall.

Explaining the Vocabulary of the Gender Spectrum

“If not men’s and women’s sports categories, then how do we organize sports fairly?”

Creating a third, mixed category for trans, non-binary, cis men and women to compete against each other can be an earnest, motivating place to start making sports more inclusive. Mixed-gender sports teams are a widely debated topic and have been for many years, just not in relation to opportunities for transgender people. But, introducing more mixed-gender sports teams would also facilitate accessibility for transgender people. The IOC did well, when in June 2017, it added mixed-sex events in athletics, swimming, table tennis, and triathlon to the upcoming Summer Olympics schedule in Tokyo 2020 , in addition to the traditional categories. This not only allows trans and intersex athletes to compete in the sports category congruent with their gender identity based on their athletic ability alone, Tokyo 2020’s milestone mixed-sex events are a concrete step towards ungendering sports. (It is important here to note this will all be moot unless the IOC allows trans and intersex athletes to compete — in these mixed events at least — without having to meet any criteria other than being a human adult who’s good enough to qualify.)

Another way to organize sports, as suggested by Alison Heather, a physiologist at the University of Otago in New Zealand, and her colleagues in an essay  published in the Journal of Medical Ethics , would be to create a system that uses an algorithm to account for physiological factors such as testosterone, height, and endurance, and social factors like gender identity and socioeconomic status. Sure it’s a Herculean task, but international sports bodies have enough money to at least begin research into the idea if it means a more inclusive world.

Apart from this, sports can also be organized on the basis of other factors such as weight class, professional/amateur status, and size. The idea is that through a mixture of formats, we redesign sports to make them more inclusive.

It’s going to take fresh thinking and self-awareness that what we believe to be facts about sex and gender are not unquestionable. But every individual must have the possibility of practicing sport, without discrimination of any kind, and in the spirit which requires mutual understanding, with a spirit of friendship, solidarity and fair play. Those are not my words, that’s the Olympic charter.

Pallavi Prasad is The Swaddle's Features Editor. When she isn't fighting for gender justice and being righteous, you can find her dabbling in street and sports photography, reading philosophy, drowning in green tea, and procrastinating on doing the dishes.

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Table of contents

Introduction, irreversible changes due to testosterone:, hormone treatment:, genetic outliers:.

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• Dreger, A. (2010). Sex typing for sport. ​Hastings Center Report​, ​40​(2), 22-24. https://doi.org/10.1353/hcr.0.0250
• Griffin, P., & Carroll, H. (2011). ​NCAA inclusion of transgender student athletes​ [Handbook]. Retrieved from https://www.ncaa.org/sites/default/files/Transgender_Handbook_2011_Final.pdf
• Harper, J. (2015, April 1). Do transgender athletes have an edge? I sure don't. ​The Washington Post​, pp. 1-3. Retrieved from https://www.washingtonpost.com/opinions/do-transgender-athletes-have-an-edge-i-sure-dont/2015/04/01/ccacb1da-c68e-11e4-b2a1-bed1aaea2816_story.html
• Heldman, G. (1976, October 29). Tennis doctor's dilemma. ​The Times​.
• Penny, L. (2016). Fighting words. ​New Statesman​, ​145​(5324), 27. Retrieved from Ebsco: Academic Search Premier database.
• Radachowsky, C. (2019, October 13). Justice' for trans athletes is unfair to girls like my daughter. New York Post​, pp. 1-2. Retrieved from https://nypost.com/2019/10/13/justice-for-trans-athletes-is-unfair-to-girls-like-my-daughter/
• Reeser, J. C. (2005). Gender identity and sport: Is the playing field level? ​British Journal of Sports Medicine​, ​39​(10), 695-699. http://dx.doi.org/10.1136/bjsm.2005.018119
• Torre, P. S., & Epstein, D. (2012, May 28). The transgender athlete. ​Sports Illustrated​, ​116​(22), 66-73. Retrieved from Ebsco: Academic Search Premier database.
• Vilain, E., Martínez-Patiño, M., & Sánchez, F. (2013). The new policy on hyperandrogenism in elite female athletes is not about 'sex testing'. ​Journal of Sex Research​, ​50​(2), 112-115. https://doi.org/10.1080/00224499.2012.752429

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TOP 100 Gender Equality Essay Topics

Table of Contents

Need ideas for argumentative essay on gender inequality? We’ve got a bunch!

… But let’s start off with a brief intro.

What is gender equality?

Equality between the sexes is a huge part of basic human rights. It means that men and women have the same opportunities to fulfil their potential in all spheres of life.

Today, we still face inequality issues as there is a persistent gap in access to opportunities for men and women.

Women have less access to decision-making and higher education. They constantly face obstacles at the workplace and have greater safety risks. Maintaining equal rights for both sexes is critical for meeting a wide range of goals in global development.

Inequality between the sexes is an interesting area to study so high school, college, and university students are often assigned to write essays on gender topics.

In this article, we are going to discuss the key peculiarities of gender equality essay. Besides, we have created a list of the best essay topic ideas.

What is the specifics of gender equality essay?

Equality and inequality between the sexes are important historical and current social issues which impact the way students and their families live. They are common topics for college papers in psychology, sociology, gender studies.

When writing an essay on equality between the sexes, you need to argue for a strong point of view and support your argument with relevant evidence gathered from multiple sources.

But first, you’d need to choose a good topic which is neither too broad nor too narrow to research.

Research is crucial for the success of your essay because you should develop a strong argument based on an in-depth study of various scholarly sources.

Equality between sexes is a complex problem. You have to consider different aspects and controversial points of view on specific issues, show your ability to think critically, develop a strong thesis statement, and build a logical argument, which can make a great impression on your audience.

If you are looking for interesting gender equality essay topics, here you will find a great list of 100 topic ideas for writing essays and research papers on gender issues in contemporary society.

Should you find that some topics are too broad, feel free to narrow them down.

Powerful gender equality essay topics

Here are the top 25 hottest topics for your argumentative opinion paper on gender issues.

Whether you are searching for original creative ideas for gender equality in sports essay or need inspiration for gender equality in education essay, we’ve got you covered.

Use imagination and creativity to demonstrate your approach.

• Analyze gender-based violence in different countries
• Compare wage gap between the sexes in different countries
• Explain the purpose of gender mainstreaming
• Implications of sex differences in the human brain
• How can we teach boys and girls that they have equal rights?
• Discuss gender-neutral management practices
• Promotion of equal opportunities for men and women in sports
• What does it mean to be transgender?
• Discuss the empowerment of women
• Why is gender-blindness a problem for women?
• Why are girls at greater risk of sexual violence and exploitation?
• Women as victims of human trafficking
• Analyze the glass ceiling in management
• Impact of ideology in determining relations between sexes
• Obstacles that prevent girls from getting quality education in African countries
• Why are so few women in STEM?
• Major challenges women face at the workplace
• How do women in sport fight for equality?
• Women, sports, and media institutions
• Contribution of women in the development of the world economy
• Role of gender diversity in innovation and scientific discovery
• What can be done to make cities safer for women and girls?
• International trends in women’s empowerment
• Role of schools in teaching children behaviours considered appropriate for their sex
• Feminism on social relations uniting women and men as groups

Gender roles essay topics

We can measure the equality of men and women by looking at how both sexes are represented in a range of different roles. You don’t have to do extensive and tiresome research to come up with gender roles essay topics, as we have already done it for you.

Have a look at this short list of top-notch topic ideas .

• Are paternity and maternity leaves equally important for babies?
• Imagine women-dominated society and describe it
• Sex roles in contemporary western societies
• Compare theories of gender development
• Adoption of sex-role stereotyped behaviours
• What steps should be taken to achieve gender-parity in parenting?
• What is gender identity?
• Emotional differences between men and women
• Issues modern feminism faces
• Sexual orientation and gender identity
• Benefits of investing in girls’ education
• Patriarchal attitudes and stereotypes in family relationships
• Toys and games of girls and boys
• Roles of men and women in politics
• Compare career opportunities for both sexes in the military
• Women in the US military
• Academic careers and sex equity
• Should men play larger roles in childcare?
• Impact of an ageing population on women’s economic welfare
• Historical determinants of contemporary differences in sex roles
• Gender-related issues in gaming
• Culture and sex-role stereotypes in advertisements
• What are feminine traits?
• Sex role theory in sociology
• Causes of sex differences and similarities in behaviour

Gender inequality research paper topics

Examples of inequality can be found in the everyday life of different women in many countries across the globe. Our gender inequality research paper topics are devoted to different issues that display discrimination of women throughout the world.

Choose any topic you like, research it, brainstorm ideas, and create a detailed gender inequality essay outline before you start working on your first draft.

Start off with making a debatable thesis, then write an engaging introduction, convincing main body, and strong conclusion for gender inequality essay .

• Aspects of sex discrimination
• Main indications of inequality between the sexes
• Causes of sex discrimination
• Inferior role of women in the relationships
• Sex differences in education
• Can education solve issues of inequality between the sexes?
• Impact of discrimination on early childhood development
• Why do women have limited professional opportunities in sports?
• Gender discrimination in sports
• Lack of women having leadership roles
• Inequality between the sexes in work-family balance
• Top factors that impact inequality at a workplace
• What can governments do to close the gender gap at work?
• Sex discrimination in human resource processes and practices
• Gender inequality in work organizations
• Factors causing inequality between men and women in developing countries
• Work-home conflict as a symptom of inequality between men and women
• Why are mothers less wealthy than women without children?
• Forms of sex discrimination in a contemporary society
• Sex discrimination in the classroom
• Justification of inequality in American history
• Origins of sex discrimination
• Motherhood and segregation in labour markets
• Sex discrimination in marriage
• Can technology reduce sex discrimination?

Most controversial gender topics

Need a good controversial topic for gender stereotypes essay? Here are some popular debatable topics concerning various gender problems people face nowadays.

They are discussed in scientific studies, newspaper articles, and social media posts. If you choose any of them, you will need to perform in-depth research to prepare an impressive piece of writing.

• How do gender misconceptions impact behaviour?
• Most common outdated sex-role stereotypes
• How does gay marriage influence straight marriage?
• Explain the role of sexuality in sex-role stereotyping
• Role of media in breaking sex-role stereotypes
• Discuss the dual approach to equality between men and women
• Are women better than men or are they equal?
• Sex-role stereotypes at a workplace
• Racial variations in gender-related attitudes
• Role of feminism in creating the alternative culture for women
• Feminism and transgender theory
• Gender stereotypes in science and education
• Are sex roles important for society?
• Future of gender norms
• How can we make a better world for women?
• Are men the weaker sex?
• Beauty pageants and women’s empowerment
• Are women better communicators?
• What are the origins of sexual orientation?
• Should prostitution be legal?
• Pros and cons of being a feminist
• Advantages and disadvantages of being a woman
• Can movies defy gender stereotypes?
• Sexuality and politics

Feel free to use these powerful topic ideas for writing a good college-level gender equality essay or as a starting point for your study.

No time to do decent research and write your top-notch paper? No big deal! Choose any topic from our list and let a pro write the essay for you!

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Transgender social inclusion and equality: a pivotal path to development

Vivek divan.

1 United Nations Development Programme Consultant, Delhi, India

Clifton Cortez

2 United Nations Development Programme, HIV, Health, and Development Group, New York, NY, USA

Marina Smelyanskaya

3 United Nations Development Programme Consultant, New York, NY, USA

JoAnne Keatley

4 University of California, San Francisco, Center of Excellence for Transgender Health, San Francisco, CA, USA

Introduction

The rights of trans people are protected by a range of international and regional mechanisms. Yet, punitive national laws, policies and practices targeting transgender people, including complex procedures for changing identification documents, strip transgender people of their rights and limit access to justice. This results in gross violations of human rights on the part of state perpetrators and society at large. Transgender people's experience globally is that of extreme social exclusion that translates into increased vulnerability to HIV, other diseases, including mental health conditions, limited access to education and employment, and loss of opportunities for economic and social advancement. In addition, hatred and aggression towards a group of individuals who do not conform to social norms around gender manifest in frequent episodes of extreme violence towards transgender people. This violence often goes unpunished.

The United Nations Development Programme (UNDP) views its work in the area of HIV through the lens of human rights and advances a range of development solutions such as poverty reduction, improved governance, active citizenship, and access to justice. This work directly relates to advancing the rights of transgender people. This manuscript lays out the various aspects of health, human rights, and development that frame transgender people's issues and outlines best practice solutions from transgender communities and governments around the globe on how to address these complex concerns. The examples provided in the manuscript can help guide UN agencies, governments, and transgender activists in achieving better standards of health, access to justice, and social inclusion for transgender communities everywhere.

Conclusions

The manuscript provides a call to action for countries to urgently address the violations of human rights of transgender people in order to honour international obligations, stem HIV epidemics, promote gender equality, strengthen social and economic development, and put a stop to untrammelled violence.

Those who have traditionally been marginalized by society and who face extreme vulnerability to HIV find that it is their marginalization – social, legal, and economic – which needs to be addressed as the highest priority if a response to HIV is to be meaningful and effective. Trans people's experiences suggest that although HIV is a serious concern for those who acquire it, the suffering it causes is compounded by the routine indignity, inequity, discrimination, and violence that they encounter. Trans people, and particularly trans women, have articulated this often in the context of HIV [ 1 ].

For a reader who is not trans, imagine a world in which the core of your being goes unrecognized – within the family, if and when you step into school, when you seek employment, or when you need social services such as health and housing. You have no way to easily access any of the institutions and services that others take for granted because of this denial of your existence, worsened by the absence of identity documents required to participate in society. Additionally, because of your outward appearance, you may be subject to discrimination, violence, or the fear of it. In such circumstances, how could you possibly partake in social and economic development? How could your dignity and wellbeing – physical, mental, and emotional – be ensured? And how could you access crucial and appropriate information and services for HIV and other health needs?

Trans people experience these realities every day of their lives. Yet, like all other human beings, trans people have fundamental rights – to life, liberty, equality, health, privacy, speech, and expression [ 2 ], but constantly face denial of these fundamental rights because of the rejection of the trans person's right to their gender identity. In these circumstances, there can be no attainment of the goal of universal equitable development as set out in the 2030 Agenda for Sustainable Development [ 3 ], and no effort to stem the tide of the HIV epidemic among trans people can succeed if their identity and human rights are denied.

The human rights gap – stigma, discrimination, violence

The ways in which marginalization impacts a trans person's life are interconnected; stigma and transphobia drive isolation, poverty, violence, lack of social and economic support systems, and compromised health outcomes. Each circumstance relates to and often exacerbates the other [ 4 ].

Trans people who express their gender identity from an early age are often rejected by their families [ 5 ]. If not cast out from their homes, they are shunned within households resulting in lack of opportunities for education and with no attempts to ensure attention to their mental and physical health needs. Those who express their gender identities later in life often face rejection by mainstream society and social service institutions, as they go about undoing gender socialization [ 6 ]. Hostile environments that fail to understand trans people's needs threaten their safety and are ill-equipped to offer sensitive health and social services.

Such discriminatory and exclusionary environments fuel social vulnerability over a lifetime; trans people have few opportunities to pursue education, and greater odds of being unemployed, thereby experiencing inordinately high levels of homelessness [ 6 ] and poverty [ 7 ]. Trans students experience resentment, prejudice, and threatening environments in schools [ 8 ], which leads to significant drop-out rates, with few trans people advancing to higher education [ 9 ].

Workplace-related research on lesbian, gay, bisexual, and trans (LGBT) individuals reveals that trans workers are the most marginalized and are excluded from gainful employment, with discrimination occurring at all phases of the employment process, including recruitment, training opportunities, employee benefits, and access to job advancement [ 10 ]. This environment inculcates pessimism and internalized transphobia in trans people, discouraging them from applying for jobs [ 11 ]. These extreme limitations in employment can push trans people towards jobs that have limited potential for growth and development, such as beauticians, entertainers or sex workers [ 12 ]. Unemployment and low-paying or high risk and unstable jobs feed into the cycle of poverty and homelessness. When homeless trans people seek shelter, they are housed as per their sex at birth and not their experienced gender, and are subject to abuse and humiliation by staff and residents [ 13 ]. In these environments, many trans people choose not to take shelter [ 14 ].

Legal systems often entrench this marginalization, feed inequality, and perpetuate violence against trans people. All people are entitled to their basic human rights, and nations are obligated to provide for these under international law, including guarantees of non-discrimination and the right to health [ 2 ]; however, trans people are rarely assured of such protection under these State obligations.

Instead, trans people often live in criminalized contexts – under legislation that punishes so-called unnatural sex, sodomy, buggery, homosexual propaganda, and cross-dressing [ 12 ] – making them subject to extortion, abuse, and violence. Laws that criminalize sex work lead to violence and blackmail from the police, impacting trans women involved in this occupation [ 15 ]. Being criminalized, trans people are discouraged from complaining to the police, or seeking justice when facing violence and abuse, and perpetrators are rarely punished. When picked up for any of the aforementioned alleged crimes or under vague “public nuisance” or “vagrancy” laws, their abuse can continue at the hands of the police [ 16 ] or inmates in criminal justice systems that fail to appropriately respond to trans identities.

The transphobia that surrounds trans people's lives fuels violence against them. Documentation over the last decade reveals the disproportionate extent to which trans people are murdered, and the extreme forms of torture and inhuman treatment they are subject to [ 16 – 18 ]. When such atrocities are perpetrated against trans people, governments turn a blind eye. Trans sex workers are particularly vulnerable to brutal police conduct including rape, sometimes being sexually exploited by those who are meant to be protectors of the law [ 15 ]. In these circumstances, options to file complaints are limited and, when legally available channels do exist, trans complainants are often ignored [ 19 ].

These experiences of severe stigma, marginalization, and violence by families, communities, and State actors lead to immense health risks for trans people, including heightened risk for HIV, mental health disparities, and substance abuse [ 20 , 21 ]. However, most health systems struggle to function outside the traditional female/male binary framework, thereby excluding trans people [ 22 ]. Health personnel are often untrained to provide appropriate services on HIV prevention, care, and treatment or information on sexual and reproductive health to trans people [ 20 , 23 ]. HIV voluntary counselling and testing facilities and antiretroviral therapy (ART) sites intimidate trans people due to prior negative experiences with medical staff [ 21 , 24 , 25 ]. Additionally, when trans women test HIV positive, they are wrongly reported as men who have sex with men [ 4 ]. Consequently, testing rates in trans communities are low [ 26 ], which serves to disguise the serious burden of HIV among trans people and perpetuates the lack of investment in developing trans-sensitive health systems. The economic hardships that trans people face due to their inability to participate in the workforce further complicate access to HIV, mental health, and gender-affirming health services. In short, hostile social and legal environments contribute to health gaps, and public health systems that are unresponsive to the needs of trans people.

In addition, understanding of trans people's concerns around stigma, discrimination, and violence, related as they are to gender identity, is often limited due to their being combined with lesbian, gay, and bisexual sexual orientation issues. However, trans people's human rights concerns, grounded in their gender identity, are inherently different and necessitate their own set of approaches.

Imperatives for trans social inclusion

In order to overcome the human rights barriers trans people confront, certain measures are imperative and should be self-evident, given the standards that States are obliged to provide under international law to all human beings. Paying attention to these is key to effectively addressing the systemic marginalization that trans people experience. Such action can have immeasurable benefits, including the full participation of trans people in human development processes as well as positive health and HIV outcomes. For trans people, the change must begin with the most fundamental element – acknowledgement of their gender identity.

The right to gender recognition

For trans people, their very recognition as human beings requires a guarantee of a composite of entitlements that others take for granted – core rights that recognize their legal personhood. As the Global Commission on HIV and the Law pointed out, “In many countries from Mexico to Malaysia, by law or by practice, transgender persons are denied acknowledgment as legal persons. A basic part of their identity – gender – is unrecognized” [ 19 ]. This recognition of their gender is core to having their inherent dignity respected and, among other rights, their right to health including protection from HIV. When denied, trans people face severe impediments in accessing appropriate health information and care.

Recognizing a trans person's gender requires respecting the right of that person to identify – irrespective of the sex assigned to them at birth – as male, female, or a gender that does not fit within the male–female binary, a “third” gender as it were, as has been expressed by many traditionally existing trans communities such as hijras in India [ 27 ]. This is an essential requirement for trans people to attain full personhood and citizenship. The guarantee of gender recognition in official government-issued documents – passports and other identification cards that are required to open bank accounts, apply to educational institutions, enter into housing or other contracts or for jobs, to vote, travel, or receive health services or state subsidies – provides access to a slew of activities that are otherwise denied while being taken for granted by cisgender people. 1 Such recognition results in fuller civic participation of and by trans people. It is a concrete step in ensuring their social integration, economic advancement, and a formal acceptance of their legal equality. It can immeasurably support their empowerment and act as an acknowledgement of their dignity and human worth, changing the way they are perceived by their families, by society in general, and by police, government actors, and healthcare personnel whom they encounter in daily life. UN treaty bodies have acknowledged this vital right of trans people to be recognized. The UN High Commissioner for Human Rights has recommended that States “facilitate legal recognition of the preferred gender of transgender persons and establish arrangements to permit relevant identity documents to be reissued reflecting preferred gender and name, without infringements of other human rights” [ 28 ].

Freedom from violence & discrimination

Systemic strategies to reduce the violence against trans people need to occur at multiple levels, including making perpetrators accountable, facilitating legal and policy reform that removes criminality, and general advocacy to sensitize the ill-informed about trans issues and concerns. Strengthening the capacity of trans collectives and organizations to claim their rights can also act as a counter to the impunity of violence. When trans people are provided legal aid and access to judicial processes, accountability can be enforced against perpetrators. Sensitizing the police to make them partners in this work can be crucial. When political will is absent to support such attempts in highly adverse settings, trans organizations and allies can consider using international human rights mechanisms, such as shadow reports made to UN human rights processes like the Universal Periodic Review, to bring focus to issues of anti-trans violence and other human rights violations against trans people.

Providing equal access to housing, education, public facilities and employment opportunities, and developing and implementing anti-discrimination laws and policies that protect trans people in these contexts, including guaranteeing their safety and security, are essential to ensure that trans individuals are treated as equal human beings.

The right to health

For trans people, their right to health can only be assured if services are provided in a non-stigmatizing, non-discriminatory, and informed environment. This requires working to educate the healthcare sector about gender identity and expression, and zero tolerance for conduct that excludes trans people. Derogatory comments, breaches of confidentiality from providers, and denial of services on the basis of gender identity or HIV status are some of the manifestations of prejudice. The right to non-discrimination that is guaranteed to all human beings under international law must be enforced against actions that violate this principle in the healthcare system. Yet, a multi-pronged approach that supports this affirmation of trans equality together with a sensitized workforce that is capable of delivering gender-affirming surgical and HIV health services is necessary.

Building on the commitments made by the UN General Assembly in response to the HIV epidemic [ 29 ], the World Health Organization (WHO) developed good practice recommendations in relation to stigma and discrimination faced by key populations, including trans people [ 30 ]. These recommendations urge countries to introduce rights-based laws and policies and advise that, “Monitoring and oversight are important to ensure that standards are implemented and maintained.” Additionally, mechanisms should be made available “to anonymously report occurrences of stigma and/or discrimination when [trans people] try to obtain health services” [ 30 ].

Fostering stigma-free environments has been successfully demonstrated – where partnerships between trans individuals and community health nurses have improved HIV-related health outcomes [ 31 ], or where clinical sites welcome trans people and conduct thorough and appropriate physical exams, manage hormones with particular attention to ART, and engage trans individuals in HIV education [ 32 ].

Advancing trans human rights and health

For all the challenges faced by trans people in the context of their human rights and health, promising interventions and policy progress have shown that positive change is possible, although this must be implemented at scale to have significant impact. Change has occurred due to the efforts of trans advocates and human rights champions, often in critical alliances with civil society supporters as well as sensitized judiciaries, legislatures, bureaucrats, and health sector functionaries.

Key strides have been made in the context of gender recognition in some parts of the world. In the legislatures, this trend began in 2012 with Argentina passing the Gender Identity and Health Comprehensive Care for Transgender People Act , which provided gender recognition to trans people without psychiatric, medical, or judicial evaluation, and the right to access free and voluntary transitional healthcare [ 33 , 34 ]. In 2015, Malta passed the Gender Identity, Gender Expression and Sex Characteristics Act , which provides a self-determined, speedy, and accessible gender recognition process. The law protects against discrimination in the government and private sectors. It also de-pathologizes gender identity by stating that people “shall not be required to provide proof of a surgical procedure for total or partial genital reassignment, hormonal therapies or any other psychiatric, psychological or medical treatment.” It presumes the capacity of minors to exercise choice in opting for gender reassignment, while recognizing parental participation and the minor's best interests. It stipulates the establishment of a working group on trans healthcare to research international best practices [ 35 ]. Pursuant to its passing the Maltese Ministry of Education working with activists also developed policy guidelines to accommodate trans, gender variant, and intersex children in the educational system [ 36 ]. Other countries, such as the Republic of Ireland and Poland, have also passed gender identity and gender expression laws, albeit of varying substance but intended to recognize the right of trans people to personhood [ 37 , 38 ]. Denmark passed legislation that eliminated the coercive requirement for sterilization or surgery as a prerequisite to change legal gender identity [ 39 ].

Trans activists and allies have also used the judicial process to claim the right to gender recognition. In South Asia, claims to recognition of a gender beyond the male–female binary have been upheld – in 2007, the Supreme Court of Nepal directed the government to recognize a third gender in citizenship documents in order to vest rights that accrue from citizenship to metis [ 40 ]; in Pakistan, the Supreme Court directed the government to provide a third gender option in national identity cards for trans people to be able to vote [ 41 ]; in 2014, the Indian Supreme Court passed a judgement directing the government to officially recognize trans people as a third gender and to formulate special programmes to support their needs [ 42 ]. These developments in law, while hopeful, are too recent to yet discern any resultant trends in improvements in trans peoples’ lives, more broadly.

More localized innovative efforts have also been made by trans organizations to counter violence, stigma, and discrimination. For instance in South Africa, Gender DynamiX, a non-governmental organization worked with the police to change the South African Police Services’ standard operating procedures in 2013. The procedures are intended to ensure the safety, dignity, and respect of trans people who are in conflict with the law, and prescribe several trans-friendly safeguards – the search of trans people as per the sex on their identity documents, irrespective of genital surgery, and detention of trans people in separate facilities with the ability to report abuse, including removal of wigs and other gender-affirming prosthetics. Provision is made for implementation of the procedures through sensitization workshops with the police [ 43 ]. In Australia, the Transgender Anti-Violence Project was started as a collaboration between the Gender Centre in Sydney and the New South Wales Police Force, the City of Sydney and Inner City Legal Centre in 2011. It provides education, referrals, and advocacy in relation to violence based on gender identity, and support for trans people when reporting violence, assistance in organizing legal aid and appearances in court [ 44 ].

Measures have also been taken to tackle discrimination faced by trans people, in recognition of their human rights – in 2015, Japan's Ministry of Education ordered schools to accept trans students according to their preferred gender identity [ 45 ]; in 2014 in Quezon City, the Philippines the municipal council passed the “Gender Fair City” ordinance to ensure non-discrimination of LGBT people in education, the workplace, media depictions, and political life. This law prohibits bullying and requires gender-neutral bathrooms in public spaces and at work [ 46 ]; in Ecuador, Alfil Association worked on making healthcare accessible to trans people, including training and sensitization meetings for health workers and setting up a provincial health clinic for trans people in collaboration with the Ministry of Health, staffed by government physicians who had undergone the training; and Transbantu Zambia set up a small community house providing temporary shelter for trans people, assisting them in difficult times or while undergoing hormone therapy. Similar housing support has been provided by community organizations with limited resources in Jamaica and Indonesia. 2

Towards sustainable development: time for change

Although there are other examples of human rights progress for trans people, much of this change is isolated, non-systemic, and insufficient. Trans people continue to live in extremely hostile contexts. What is required is change and progress at scale. The international community's recent commitment towards Sustainable Development Goals (SDGs) presents an opportunity to catalyze and expand positive interventions [ 3 ].

Preventing human rights violations and social exclusion is key to sustainable and equitable development. This is true for trans people as much as other human beings, just as the achievement of all 17 SDGs is of paramount importance to all people, including trans people. Of these SDGs, the underpinning support for trans people's health and human rights is contained in SDG 3 –“Ensure healthy lives and promote well-being for all at all ages,” SDG 10 – “Reduce inequality within and among countries,” and SDG 16 – “Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels.”

The SDGs are guided by the UN Charter and grounded in the Universal Declaration of Human Rights. They envisage processes that are “people-centered, gender-sensitive, respect human rights and have a particular focus on the poorest, most vulnerable and those furthest behind” and a “just, equitable, tolerant, open and socially inclusive world in which the needs of the most vulnerable are met” [ 3 ]. They reiterate universal respect for human rights and dignity, justice and non-discrimination, and a world of equal opportunity permitting the full realization of human potential for all irrespective of race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth, disability, or other status . The relationship between the SDGs and trans people's concerns has been robustly articulated in the context of inclusive development [ 47 ].

UN Member States have unequivocally agreed to this new common agenda for the immediate future. The SDGs demand an unambiguous, farsighted, and inclusive demonstration of political will. Their language clearly reflects the most urgent needs of trans people, for whom freedom from violence and discrimination, the right to health and legal gender recognition are inextricably linked.

Specifically in regard to trans people, the SDGs are a call to immediate action on several fronts: governments need to engage with trans people to understand their concerns, unequivocally support the right of trans people to legal gender recognition, support the documentation of human rights violations against them, provide efficient and accountable processes whereby violations can be safely reported and action taken, guarantee the prevention of such violations, and ensure that the whole gamut of robust health and HIV services are made available to trans people. Only then can trans people begin to imagine a world that respects their core personhood, and a world in which dignity, equality, and wellbeing become realities in their lives.

Acknowledgements and funding

The authors are grateful for the work of courageous trans activists around the world who have overcome tremendous challenges and continue to battle disparities as they bring about positive change. Many encouraging examples cited in this manuscript would be impossible without their contribution. The authors also thank Jack Byrne, an expert on trans health and human rights, whose work on the UNDP Discussion Paper on Transgender Health and Human Rights (2013) served as an inspiration for this piece, and JoAnne Keatley's effort to provide writing, editorial comment, and oversight. UNDP staff and consultants, who contributed time to this manuscript, were supported by UNDP.

1 Cisgender people identify and present in a way that is congruent with their birth-assigned sex. Cisgender males are birth-assigned males who identify and present themselves as male.

2 These illustrations are based on information gathered in the process of developing a tool to operationalize the Consolidated Guidelines on HIV prevention, diagnosis, treatment and care for key populations (WHO, 2014), through interviews with and questionnaires sent to trans activists. See also reference 31.

Competing interests

The authors have declared that no competing interests exist.

Authors' contributions

The concept for this manuscript was a result of collaborative work between all four authors. VD provided key ideas for content and led the writing for the manuscript. CC provided thought leadership and contributed writing, particularly on the SDGs, while MS provided writing and editorial input, as well as other support. JK advised on content and provided writing and editorial input and guidance. All authors have read and approved the final version.

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• What Is Cinema?

Monica Lewinsky: In Praise of Alternate Endings, 10 Years After My First VF Essay

Never lose hope.

“I love you. Bye, Felicia !” I texted my friend Katerina on October 27, 2016. The sassy send-off had been in the culture for two decades (a reference from the film Friday ), but it had only crossed our transom that year. We used it affectionately and, therefore, ironically. Unbeknownst to me, it would be our last text exchange. She died unexpectedly on November 1.

Our friendship had been a salvation in the latter half of what I now call my Dark Decade, roughly 2004 to 2014. Though that stretch of time included some moments of joy, they were few and far between. For the most part, I was in a sea of pain, coming to grips with what it meant to have been standing at the center of a political sex scandal in which I was opposing the most powerful man in the world. Coming to grips with the trauma that grew around me, like weeds, as a result of the public revelations of my private life, the ensuing media circus, an impeachment trial. Coming to grips with what my future might look like. Answer: It looked fucking bleak. I was unemployable. And I was Angry.

Katerina, an entrepreneur and activist, was whip-smart about current events, world history, and spiritual matters. She had a roaring, infectious laugh. She was also kind. You would hardly know that less than a decade earlier, in a freak accident, she had broken her back in five places. After being reassembled with metal rods, she was told she’d likely never walk again. “Screw that,” she would say, “pun intended.” She didn’t lose hope and instead insisted on an alternate ending, prognosis be damned. With grit (and some luck), she recovered and did indeed walk again. And she walked tall.

Our conversations spanned the personal and the political. In 2013, as Edward Snowden leaked classified NSA documents, exposing an array of methods the government and European allies used to spy on private citizens, Kat posited that 15 years earlier, the Starr Report had catapulted us all into what she termed the Age of Transparency. We’d had explosive disclosures in politics before: the Pentagon Papers, Watergate , Iran-Contra. But at their core, these were military, political, professional; 1998 was personal. A boss having an extramarital affair with a young subordinate. A politician abusing power. People, under oath, lying about sex. Rumors titillating the Beltway and beyond. All ordinaire. Almost quotidian. But this time was different. As the truth was made public, published in full on the internet, the personal behavior of a private citizen (me)—along with the actions of others, which had typically been obfuscated by power, gender, status, and wealth—was laid bare. And this transparency led to historical and cultural shifts.

Kat made the point that after 1998, for better or for worse, becoming transparent meant becoming Seen—in new and sometimes disturbing ways. And year upon year, we began to peek behind the veil in all facets of life and culture, thanks to the Patriot Act, reality television, the truth about weapons of mass destruction, the advent of social media, Wikileaks, 23andMe, the UK tabloid phone hacking scandal, and on and on.

Kat’s argument was compelling. And a year after Snowden’s data dump, 2014, I would find myself impacted by this Age of Transparency yet again, this time gratefully.

Ten years ago, after a decade of self-imposed silence in which I had retreated from a world that still shamed me, after a decade of involution and integration (and a fuckton of healing), I jumped back into the public conversation. With no safety net. And I found my voice…by writing for this magazine.

In many ways, my 2014 essay, “ Shame and Survival ,” was a social experiment. Vanity Fair and its then editor, Graydon Carter, could have been lambasted for giving someone from a 15-year-old news story, well, 15 more minutes. And not just in a splashy interview, but in a first-person essay in which I allowed myself to be transparent—and unblinking. (The first line was “How does it feel to be America’s blow job queen?”) I was no longer mediated through another’s gaze but stepping forward unabashedly.

And something surprising happened. A generation that hadn’t lived through the Brainwashing of 1998 insisted on reevaluating this story, one that, given government and judicial overreach, given the technological and tabloid explosion, had always been bigger than me and any one of the other players in it. It had always been a story about the culture at large, and why in my original piece I had referred to myself as a social canvas.

What followed was a Big Fat Fucking Miracle™. My life changed, and I’ll be forever thankful.

That doesn’t mean it has been all smooth sailing. Hardly. Over the years, I’ve spoken confidentially to many people who have been publicly shamed and have explained that taking back one’s narrative doesn’t happen overnight and is (annoyingly) replete with plenty of setbacks. While the essay went on to be nominated for a National Magazine Award (I’m not kidding, alongside pieces by Ta-Nehisi Coates and Roger Angell—Angell won), the following month I attended a party in LA and a famous diva asked me, point-blank, if I was someone’s plus-one. When I replied I had been invited, she snarked, “They just let everyone in tonight, didn’t they?” (Yes, really.)

It went on like this. I gave my first major public speeches: at the Forbes 30 Under 30 conference and, several months later, in 2015, at TED in Vancouver. But mere minutes after my TED Talk, “The Price of Shame ,” went online, the level of vitriol, misogyny, and hatred spewed at me in the comments section was worse than anything the TED team had experienced before. (Who knew there were so many ways to say whore ?) Soon I began working with anti-bullying organizations globally. And yet, when one of the groups was being honored at an event, I was asked not to walk the red carpet.

In 2018, I was asked by Vanity Fair ’s newly appointed editor, Radhika Jones, to address the #MeToo moment in an essay in which I unpacked my own thoughts about what constituted consent in a workplace relationship with a quintessential power differential. Shortly thereafter I was disinvited to a philanthropy summit because former president Bill Clinton was a last-minute addition to the roster.

I could go on for hours. If this last decade has shown me anything, it’s that we never know what lurks or enlivens around the next corner. That one essay, where someone took a chance on me, helped set my life on a different course.

My friend Katerina, who is intensely missed, was not as fortunate. One night she had dined out with her husband and developed what became a fatal case of food poisoning. She was hospitalized, sepsis set in, and she quickly passed. But to this day she remains Seen, in all her common majesty, by everyone who encountered her in life.

After all, in the end what matters more than how it all began is how we have been Seen . And as Rumi wrote:

Never lose hope, dear heart. Miracles swell in the invisible.

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Monica Lewinsky

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Pamela Paul

Why Is the U.S. Still Pretending We Know Gender-Affirming Care Works?

By Pamela Paul

Opinion Columnist

Imagine a comprehensive review of research on a treatment for children found “remarkably weak evidence” that it was effective. Now imagine the medical establishment shrugged off the conclusions and continued providing the same unproven and life-altering treatment to its young patients.

This is where we are with gender medicine in the United States.

It’s been three months since the release of the Cass Review, an independent assessment of gender treatment for youths commissioned by England’s National Health Service . The four-year review of research, led by Dr. Hilary Cass, one of Britain’s top pediatricians, found no definitive proof that gender dysphoria in children or teenagers was resolved or alleviated by what advocates call gender-affirming care, in which a young person’s declared “gender identity” is affirmed and supported with social transition, puberty blockers and/or cross-sex hormones. Nor, she said, is there clear evidence that transitioning kids decreases the likelihood that gender dysphoric youths will turn to suicide, as adherents of gender-affirming care claim. These findings backed up what critics of this approach have been saying for years.

“The reality is that we have no good evidence on the long-term outcomes of interventions to manage gender-related distress,” Cass concluded. Instead, she wrote, mental health providers and pediatricians should provide holistic psychological care and psychosocial support for young people without defaulting to gender reassignment treatments until further research is conducted.

After the release of Cass’s findings, the British government issued an emergency ban on puberty blockers for people under 18. Medical societies, government officials and legislative panels in Germany, France, Switzerland, Scotland , the Netherlands and Belgium have proposed moving away from a medical approach to gender issues , in some cases directly acknowledging the Cass Review. Scandinavian countries have been moving away from the gender-affirming model for the past few years. Reem Alsalem, the United Nations special rapporteur on violence against women and girls, called the review’s recommendations “seminal” and said that policies on gender treatments have “ breached fundamental principles ” of children’s human rights, with “devastating consequences.”

But in the United States, federal agencies and professional associations that have staunchly supported the gender-affirming care model greeted the Cass Review with silence or utter disregard.

There’s been no response from the Department of Health and Human Services , whose website says that “gender-affirming care improves the mental health and overall well-being of gender diverse children and adolescents” and which previously pushed to eliminate recommended age minimums for gender surgery . Nor has there been a response from the American Medical Association , which also backs gender-affirming care for pediatric patients .

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