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Position on the Dignity and Rights of Transgender and Gender-Expansive Individuals
As one of the nation’s leading organizations of sexuality professionals, The American Association of Sex Educators, Counselors, and Therapists (AASECT) advocates for all people to have access to high-quality sexual education and healthcare. Marginalized communities, including transgender and gender-expansive people, continue to face barriers in both areas, at great cost to individuals, communities, and broader society.
AASECT affirms the dignity and rights of transgender and gender-expansive (TGE) individuals and communities, and aims to help create a safe and welcoming environment in which TGE people can feel affirmed, empowered, and respected.
Additionally, AASECT stands alongside many other established organizations—including the American Psychological Association, the American Civil Liberties Union, The American Medical Association, the American Academy of Pediatrics, the American Psychiatric Association, the Endocrine Society, The Pediatric Endocrine Society, and many others —in our opposition to the many ongoing attempts to strip the rights and access to healthcare of TGE people of all ages. Hundreds of methodologically solid research studies have consistently demonstrated that optimal social and health outcomes are achieved when TGE people are provided safe, affirming environments in which to examine their genders without judgment and to arrive at their own conclusions. In contrast, the proposed and sometimes enacted disaffirming policies are well-demonstrated to cause harm. Accordingly, we strongly assert that the role of the therapist is to aid clients in a non-judgmental exploration of the gendered aspects of themselves and the relationships of those gendered aspects for the rest of their lives. Any form of gatekeeping or conversion/reparative therapy is unethical.
As self-determination is central to ethical healthcare, the members of AASECT strive to practice radical acceptance of the identities and self-expressions of the individuals we serve, to follow their lead in supporting their wellbeing and self-actualization. We acknowledge the fundamental right of body autonomy. We recognize the power dynamic inherent in our positionalities and social locations as providers and aim to use these privileges to advocate for our TGE clients and students, and to amplify their voices.
Gender dysphoria, the name used by the American Psychiatric Association (APA, 2013) to describe the distress arising from conflicts between a person’s gender identity or expression and their assigned gender/sex, has received significant attention in literature and research during recent years. The recognition of gender dysphoria has been important for addressing the harmful impact of societal gender constructs and making healthcare services accessible for people whose marginalized gender identity or expression is causing distress. However, trans theorists and community members have also criticized the focus on dysphoria as solely emphasizing the negative, over-medicalized aspects of gender/sex minority experiences (Beischel, Gauvin & van Anders, 2021; Fielding, 2021).
As a collective of providers committed to accessible and compassionate healthcare, AASECT recognizes the unfortunate reality that many of our members are in positions of power and act as gatekeepers in the managed care system in which diagnoses are required to make healthcare accessible. The validity of gender dysphoria as a mental disorder is dubious in that the distress experienced by the majority of the barriers and symptoms TGE people experience is caused by a reaction to the stigma, discrimination, and mistreatment by medical and mental health professionals and society at large. We aim to practice transparency with the people we serve about our assigned roles as gatekeepers and to do our best to redistribute this misdirected power toward empowering them. We urge providers to move away from a diagnostic model of care and instead to practice according to informed consent models of care (Schulz, 2018).
AASECT affirms the concept of gender euphoria, which Ashley and Ells (2018) describe as a “distinct enjoyment or satisfaction… seemingly central to these positive emotions are a constellation of feelings related to authenticity, rightness, or being ‘at home.’” TGE individuals benefit greatly when clinicians aid not only in managing gender dysphoria, but also in facilitating euphoria with a strengths-based exploration of how they experience joy, contentment, validation, and resilience in their gender identity and expression.
The consequences of limiting the rights of and access to care for TGE people of all ages, including increased rates of depression, anxiety, smoking, poor school performance, self-harm, suicidal ideation and suicidal gestures, have been extensively documented (Fredriksen-Goldsen et al., 2014, Clements-Nolle et al., 2006). We are explicit in outlining that this is true for all ages to be clear that this position necessarily includes youth. Gender-affirming care is a human right and represents both a health imperative and a quality of life issue. AASECT aims to be known as a collective of providers that TGE people will actively want to seek out for the support they need, instead of avoiding us out of fear of further harm, stigmatization, and pathologization.
This statement was written in collaboration with transgender and gender expansive stakeholders, including AASECT certified sex therapists, counselors, and sex educators, and non-AASECT certified therapists and community members.
References & Resources for Further Reading
- American Psychological Association. (2015). Guidelines for Psychological Practice with Transgender and Gender Nonconforming People. American Psychologist, 70 (9), 832-864. doi: 10.1037/a0039906
- Ashley, F., & Domínguez, S. (2021). Transgender healthcare does not stop at the doorstep of the clinic. The American Journal of Medicine, 134(2), 158-160. doi: 10.1016/j.amjmed.2020.09.030
- Ashley, F., & Ells, C. (2018). In favor of covering ethically important cosmetic surgeries: Facial feminization surgery for transgender people. The American Journal of Bioethics, 18(12), 23–25. https://doi.org/10.1080/15265161.2018.1531162
- Bailey, L., Ellis, S.J., McNeil, J. (2014). Suicide risk in the UK trans topulation and the role of gender transition in decreasing suicidal ideation and suicide attempts. Mental Health Review Journal. https://www.researchgate.net/publication/281441727_Suicide_risk_in_the_U...
- Beischel, W. J., Gauvin, S. E. M., & van Anders, S. M. (2021). “A little shiny gender breakthrough”: Community understandings of gender euphoria. International Journal of Transgender Health, doi: 10.1080/26895269.2021.1915223
- Bishop, A. (2019). Harmful treatment: The global reach of so-called conversion therapy. Outright Action International. https://outrightinternational.org/sites/default/files/ConversionFINAL_1.pdf
- Clements-Nolle, K., Marx, R., & Katz, M. (2006). Attempted suicide among transgender persons: The inﬂuence of gender-based discrimination and victimization. Journal of Homosexuality, 51, 53– 69. http://dx.doi.org/10.1300/J082v51n03_04
- Cornell Chronicle. (2018). Analysis finds strong consensus on effectiveness of gender transition treatment. http://news.cornell.edu/stories/2018/04/analysis-finds-strong-consensus-...
- Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J.,...Zucker, K. (2012). Standards of care for the health of transsexual, transgender, and gender nonconforming people, 7th version. International Journal of Transgenderism, 13, 165–232. http://dx.doi.org/10.1080/15532739.2011.700873
- Fielding, L. (2021). Trans sex: Clinical approaches to trans sexualities and erotic embodiments. Routledge.
- Fredriksen-Goldsen, K. I., Cook-Daniels, L., Kim, H. J., Erosheva, E. A., Emlet, C. A., Hoy-Ellis, C. P.,...Muraco, A. (2014). Physical and mental health of transgender older adults: An at-risk and underserved population. The Gerontologist, 54, 488 –500. http://dx.doi.org/10.1093/geront/gnt021
- Hembree, W. C., Cohen-Kettenis, P., Delemarre-van de Waal, H. E., Gooren, L. J., Meyer, W. J., III, Spack, N. P.,...Montori, V. M. (2009). Endocrine treatment of transsexual persons: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology Metabolism, 94, 3132–3154. http://dx.doi.org/10.1210/jc.2009-0345
- Klein, A., & Golub, S. (2016). Family rejection as a predictor of suicide attempts and substance misuse among transgender and gender nonconforming adults. LGBT Health. https://www.liebertpub.com/doi/abs/10.1089/lgbt.2015.0111?journalCode=lgbt
- Schulz, S. L. (2018). The Informed Consent Model of Transgender Care: An Alternative to the Diagnosis of Gender Dysphoria. Journal of Humanistic Psychology, 58(1), 72–92. https://doi.org/10.1177/0022167817745217
- Sun, Simón(e) D. (2019). Stop using phony science to justify transphobia: Actual research shows that sex is anything but binary. Scientific American. https://blogs.scientificamerican.com/voices/stop-using-phony-science-to-justify-transphobia
- Travers, R., Bauer, G., Pyne, J., Bradley, K., Gale, L., Papadimitriou, M. (2012). Impacts of strong parental support for trans youth. TransPulse. https://transpulseproject.ca/wp-content/uploads/2012/10/Impacts-of-Stron...
- Turban, J.L., King, D., Carsewlland J.M., Keruoghlian, A.S.. (2020). Pubertal suppression for transgender youth and risk of suicidal ideation. Pediatrics. https://pediatrics.aappublications.org/content/145/2/e20191725?
- Yong, E. (2019). Young trans children know who they are. The Atlantic. https://www.theatlantic.com/science/archive/2019/01/young-trans-children...