Trust the Science by Supporting Trans Health Care

By Jey McCreight, PhD, Science Communication Sr. Program Manager

Pride month is a chance to celebrate the LGBTQ+ community, which is important here at 23andMe where part of our job is understanding and celebrating human diversity. But we should not forget that Pride started as a protest for LGBTQ+ rights, and despite the progress we have made, there is still work ahead.

The last year during this pandemic has been a stressful time for all of us, but even more so for transgender people, especially during the last six months as cultural conversations have shifted to put trans rights at risk. In fact, 2021 has already become the worst year in recent history for anti-LGBTQ legislation in the US. There have been more than 250 anti-LGBTQ bills introduced in state legislatures, and seventeen of those have already been enacted into law. These bills disproportionately target transgender people, especially youth. This year is also on track to become the most violent, fatal year for the trans and gender non-conforming community.

Why are we bringing this up? Because these attacks and this legislation have real implications for the health and wellbeing for trans people. For us here at 23andMe, where science is at our core, it’s particularly painful to see some of these legislative efforts pushed under the rallying cry of “trust the science.” As a health company, we feel compelled to speak up about what the science actually says.

People who fear or distrust trans people often use “biology” as a justification for attacking this community. But the reality is that the biology of sex and gender is more complicated than a simple binary. The science shows us that sex itself is not binary, but rather bimodal, with a range of diversity between the categories of male or female. Scientific research also supports the existence of trans and non-binary gender identities as a natural part of human diversity that have existed throughout history. 

But it is not enough to simply say “trans people exist.” Science also shows that trans people who are accepted and affirmed have better health outcomes and quality of life. 

Supporting Social Transition

The most well-established treatment protocol for gender dysphoria is social transition, which involves adopting a new name, using different pronouns, changing hair and clothing, and using public spaces associated with one’s gender identity. For trans youth in particular, studies have shown that having supportive family members is associated with better mental and physical health. Trans adolescents who receive gender affirmation have better academic success, relationship building, and future-orientated planning. Simply using a trans youth’s chosen name and respecting their pronouns significantly reduces their risk of depression and suicide.

Social transition also includes allowing trans individuals to play on sports teams that match their gender identity. Despite the wave of legislation attempting to ban trans youth from participating in sports, there is no scientific evidence that trans girls have inherent advantages over cis girls in sports that justify blanket bans.

Bathroom Access

Medical experts also support allowing trans people to use bathrooms and other single-sex spaces that are in accordance with one’s gender identity. Laws that seek to force trans individuals to use a restroom that does not correspond with their gender identity increases the risk for trans people to experience harassment and violent assault. Trans people often avoid public restrooms because of fear of confrontation or worse, which can lead to higher rates of dehydration, kidney issues, and urinary tract infections.

Gender-affirming health care

The American Medical Association supports gender-affirming health care, such as hormones and surgery, as receiving such care has been shown to dramatically reduce rates of suicide attempts, depression and anxiety, and substance abuse. Studies by the American Academy of Pediatrics, Cornell University, and other institutions have found that pubertal suppression treatment for trans youth was associated with lower odds of suicidal thoughts. Despite most mainstream medical associations opposing legislation that limits gender affirming medical care for trans youth, this health care has already been banned in the state of Arkansas.

Mental health

To be clear, there is no evidence that increased risk for mental illness among trans people is due to being transgender. The American Psychological Association and American Psychiatric Association have both firmly stated that this increased risk stems from stigma, social rejection, discrimination, and limited availability of gender-affirming health care services.

What 23andMe is Doing in Product

To put it succinctly, there is no debate among the medical and scientific communities when it comes to accepting and affirming the gender identities of trans people.

This is why we have spent the last year working to improve our product experience for trans and non-binary customers. This has included research on best practices recommended by LGBTQ organizations, conducting focus groups with trans customers, and consulting trans employees. When these improvements go live later this year, customers will be able to input both their sex assigned at birth and their gender during kit registration and will be able to select the relationship labels (e.g. father, uncle, brother) that best reflect their gender identity, including gender-neutral options. The option to use gender-neutral pronouns is also available to cisgender customers who may want their gender anonymous for privacy reasons. 

This is only the first step in an overall commitment to improving our offerings for trans customers. As more research becomes available, for example on how hormone replacement therapy may affect risk estimates, we hope to keep improving our reports so they are more relevant for trans customers.

A Personal Conclusion

It’s easy to read a blog post on a company site and think it’s some detached statement. But I myself am a non-binary trans person. I’m hesitant to say this because I worry that some readers will no longer trust the scientific content of this post, despite my Ph.D. or my role leading 23andMe’s Science Communication program.

That fear of turning most of society against me is why I, like so many other trans people, stayed in the closet for so long. I was terrified that coming out would ruin my career, lose my family and friends, and put me at risk of violence. That fear directly came from the media I watched growing up, which cast trans people as monsters to be feared, pitied, or ridiculed. 

But a cultural shift is clearly happening. I finally found resources and language to describe how I’ve always felt, and to realize there were other people out there like me. I met trans people in real life and saw more role models in the media that showed me that, frankly, there is nothing wrong with being trans. 

I feel lucky to work at a place where I felt comfortable enough to publicly transition without losing my job or the respect of my colleagues. Being able to have that job security, which most trans people do not, enabled me to finally be myself completely openly, including to my closest family and friends. 

Do coworkers and family still occasionally mess up my pronouns? Yes. But overall I’ve been privileged by how supportive everyone has been. I can tell they’re making an effort to do better and to learn why affirming my gender matters so much to me because they care about my health and happiness. That willingness to learn sets them apart from transphobes who refuse to listen to scientists, doctors, and most importantly, trans people themselves.

But not every trans person is as privileged as I am. Many think trans people only care about pronouns, but from legislative attacks to literal violent attacks, it is a dangerous time to be trans. Trans people of color in particular are disproportionately affected by violence, discrimination, and lack of health care. Trans youth are already having life-saving gender-affirming health care made illegal, despite medical consensus supporting that care. I wish I would have had the support and science to not go through the wrong puberty, and it breaks my heart to watch kids have that taken away.

The least I can do from my position of privilege is to speak up. Regardless of what science says, everyone should still treat trans people with respect because it’s just the right thing to do. But if you want to claim you “trust the science” in order to attack trans people, then sorry – the science says that trans rights are human rights.