A Homage to My Trans Sister
I met my foster sister almost ten years ago on a sunny day in Los Angeles, in the valley, at an all-boys group home. My mom, sister, and I excitedly drove over to meet her and see if we would get along and if this would be a good fit for the three of us girls. She instantly became our sister. We all got our own rooms. Being the older sister at 17, I promptly added her high school to my carpool drop-off route.
In the two years we got to know each other, we talked a lot about our mental health struggles stemming from traumatic experiences. For her, this included her biological family cutting her hair without her consent, her siblings calling her by her dead name, and how she ended up in an all-boys group home. She revealed stories about strangers constantly sexually harassing her. She expressed the importance of educating people about trans rights and advocating for their access to healthcare. I learned how to show up for her as an older sister, a friend, and an ally.
This experience of living in community with my new sister would inform how I show up and advocate for people like her. Nearly ten years have passed, and many things have progressed, but so many remain the same. There are so many things I wish we all knew to support her better.
I am passionate about supporting and empowering Black women, girls, and the LGBTQ+ community. As a member of these groups, advocating for them is advocating for an extension of who I am. By default, intersectionality, liberation, and justice for all are always at the top of my mind. Hearing the same stories now that my sister told me ten years ago breaks my spirit. Children are coming out as trans to their families and still being rejected, abandoned, or forced out of their homes. This displacement significantly increases their vulnerability, putting them at grave risk of gender-based violence. Without the safety and support of a stable home environment, these children are more likely to encounter escalated violence on the streets or in temporary shelters. The lack of protection and resources further exacerbates their risk, leaving them susceptible to abuse, exploitation, and other forms of violence.
In my current role, I’m privileged to work with transgender and queer-identifying youth at a school that strives to address students' academic, psychological, and social needs through comprehensive support, fostering resilience, and promoting personal growth. Every day, I witness the resilience of these children as they navigate the complexities of their identities and confront the reactions of those around them. As they face the repercussions of being their true authentic selves, they are also contending with displacement and maneuvering through the foster care system. Many face barriers to accessing the gender-affirming care they need. It is devastating to see them fight for their right to be who they are, especially when encountering roadblocks like parental consent requirements for health care.
A girl I work with reminds me of my foster sister. We had been introduced to each other a few days before I saw her crying in the hall. I asked if she was okay and if she'd like to come into the library for some privacy. She agreed and wept in the corner furthest from me. I checked with her about 15 minutes later to see if she wanted to discuss it. She shook her head no. I waited another 15 before asking again, and she was ready. She told me that she came out to her mom as trans a few months ago and was kicked out. She'd been on the streets for a couple of days, ended up defending herself, went to juvie, and has been staying at her brother's place for a couple of months now.
From my understanding, she has her own room at her brother's place and has her basic needs met. She explained how she wanted to start taking hormone replacement therapy to affirm her gender as she is 17, and it takes about a year for the hormones to take full effect, she explained. She's taken the proper steps to schedule an appointment with the doctor, who sent her home with a parental consent form. Thankfully, her brother is now technically her guardian, right? Wrong. She leaves the form out for her brother to sign, and when she gets it back the next day, she is elated to find his signature. However, next to the consent box, it's checked-marked “NO.” I saw her that day weeping as a result of this discovery. She told me her brother betrayed her, and she felt bamboozled.
Later that day, I cried for her and for my sister, whom I am no longer in contact with. I thought endlessly about my sister, wishing I had known in 2015 what I know now. I couldn't help but feel I could have been a better big sister.
If my sister had been in this situation, my mom, as her legal guardian, would have needed to give medical consent. My mother, a foster parent for about two years, knows little about her medical history, needs, and identity—similar to this student's brother. Why should someone who knows so little about you make decisions about your body and deny you the healthcare you want and need? If they don't recognize your needs or lack the tools to understand and accept you fully, they shouldn’t be able to deny you appropriate care.
As I continue learning and advocating, I keep these girls at the forefront of my mind. I wholeheartedly believe the ongoing debate about a child’s right to autonomy persists mainly for two reasons: the lack of comprehensive sexual and reproductive health education and the desire to censor certain information from children. This creates a cycle where parents avoid discussing these topics, leaving children uninformed. This approach demonizes natural bodily functions, suppresses open discussions, and perpetuates harmful cycles of violence. Without education about their bodies, health practices, and consent, children grow into adults who lack the empowerment to assert their boundaries, recognize violations, and advocate for their own health and safety.
We need to dispel the misconception that transgender youth shouldn't have autonomy over their health decisions until they reach adulthood. Firstly, what is gender-affirming care? Gender-affirming care, as defined by the World Health Organization, encompasses a range of social, psychological, behavioral, and medical interventions “designed to support and affirm an individual’s gender identity” when it conflicts with the gender they were assigned at birth. The interventions help transgender people align various aspects of their lives — emotional, interpersonal, and biological — with their gender identity (WHO, n.d.) At a younger age, this can take the form of gender expression, such as choosing names and pronouns and expressing gender through behavior and outward appearance, including dress, hair, make-up, and body language. These are things we all do as we explore ourselves. This process is everchanging.
People need to receive gender-affirming care when they feel they are ready to receive it. These cases should be treated by stage, not only by age. A study found that transgender people who began hormone treatment in adolescence had fewer thoughts of suicide, were less likely to experience significant mental health disorders, and had fewer problems with substance abuse than those who started hormones in adulthood (Stanford, 2022). The study also documented better mental health among those who received hormones at any age than those who desired but never received the treatment (Stanford, 2022). Gender-affirming hormone treatment with estrogen or testosterone can help bring a transgender person's physical characteristics in line with their gender identity (Boyle, 2022). In adolescence, hormone therapy can enable a transgender teenager to go through puberty in a way that matches their gender identity.
Here are some common myths about gender-affirming care debunked by the National Association of Social Workers.
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Fact: gender-affirming care is often life-saving and has been supported by every major U.S. medical and mental health organization, including the American Medical Association, the American Academy of Pediatrics, and the American Psychological Association, plus global health organizations, including the Endocrine Society, the Pediatric Endocrine Society, the Society for Adolescent Health and Medicine, and the World Medical Association, and the World Health Organization support access to age-appropriate, individualized gender-affirming care for youth and adults.
Gender-affirming care is recognized as medically necessary by major medical and mental health organizations, supporting transgender and non-binary individuals in living openly and authentically by aligning their physical appearance with their gender identity, ultimately promoting their overall health and well-being.
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Fact: Before puberty, transitioning is entirely social and includes changing names, pronouns, clothing, and hairstyle.
Transgender and non-binary youth undergoing transition work collaboratively with parents and healthcare providers to ensure age-appropriate decisions regarding social and medical interventions, with no permanent medical procedures occurring until informed consent is possible, potentially saving lives and promoting mental well-being.
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Fact: Hormone therapy is typically only given to people aged 18 and older. It has been proven to be safe with provider supervision and clinical management.
Gender-affirming hormones, when administered under provider supervision, offer safe and potentially life-saving benefits for transgender individuals, with studies indicating improved mental health outcomes and reduced risk of depression and suicide among teens accessing them, alongside discussions on side effects and fertility considerations during the informed consent process.
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Fact: Detransitioning is relatively rare—with some studies finding levels of detransition and regret as low as 1% or 2%. Transgender youth, when meeting criteria for gender dysphoria and undergoing social or medical transition, show high rates of consistency and persistence in their gender identity over time, with over 92% remaining consistent five years later, yet protocols ensure no irreversible changes occur without informed consent and consultation with medical and mental health providers.
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Fact: When legislation attempts to regulate who can access gender-affirming care, politicians are inserting partisan battles into private conversations and are trying to enshrine discrimination into law rather than science, medicine, and evidence.
The World Professional Association for Transgender Health (WPATH) has established clear, evidence-based standards of care for gender-affirming treatment since 1979. With increasing research, these standards have evolved to support transgender individuals better, culminating in the release of the 8th Standards of Care in 2022.
The student I am working with gave me an update this month. For the past four months, she has been determined to reschedule her hormone replacement therapy appointment while simultaneously working on her relationship with her mother, as it is required to receive parental consent as well as have a guardian present at the appointment.
Her mother finally came around, gave consent, and attended this appointment. My girl got her hormones! This is a win for our community and, most of all – her. I am glad I could be an ear and support for her in her academic journey as she navigates these personal dynamics. While I continue doing the work to push advocacy for youth bodily autonomy and health rights, we should all be fighting for equitable access to health care and rights for all and empowering our communities to make informed decisions about their bodies and health.
This can look like supporting organizations dedicated to youth health rights, such as the LGBTQ Center, The Audre Lorde Project, the Ali Forney Center, the Hetrick-Martin Institute, and more. Following their Instagram pages and more can keep you informed and engaged. Additionally, keeping track of pending legislation related to youth health and calling your representatives to voice your support can make a tangible difference. The Trevor Project has an LGBTQ+ Legislation Heatmap by State tracker you can access here. Taking these steps can ensure that all children and adolescents have the resources and support they need.
I am honored to be able to have conversations with these youth about health, wellness, and personal advocacy. Every conversation and every challenge overcome brings us closer to a future where transgender and queer youth can live authentically, supported, and celebrated for who they indeed are.
References
Boyle, Patrick. (2022, April 12). What is gender-affirming care? Your questions answered. Association of American Medical Colleges. https://www.aamc.org/news/what-gender-affirming-care-your-questions-answered
Digitale, Erin. (2022, January 12). Better mental health found among transgender people who started hormones as teens. Stanford Medicine Magazine. https://med.stanford.edu/news/all-news/2022/01/mental-health-hormone-treatment-transgender-people.html
National Association of Social Workers. (N.D.) Debunking the Myths About Gender-Affirming Care. https://www.socialworkers.org/LinkClick.aspx?fileticket=SfQYdWPJAoY%3d&portalid=0
World Professional Association for Transgender Health. (N.D.). Standards of Care for Transgender and Gender Diverse People, Version 8 Frequently Asked Questions (FAQs). https://www.wpath.org/media/cms/Documents/SOC%20v8/SOC-8%20FAQs%20-%20WEBSITE2.pdf
World Health Organization. (n.d). Gender incongruence and transgender health in the ICD. https://www.who.int/standards/classifications/frequently-asked-questions/gender-incongruence-and-transgender-health-in-the-icd
More resources
The Death and Life of Marsha P. Johnson
LGBTQ+ Youth in Foster Care 2023 Fact Sheet
TEENAGERS, HEALTH CARE, AND THE LAW
Bill Tracker | The Trevor Project
Centers to follow and support
The Lesbian, Gay, Bisexual & Transgender Community Center