Competing Ideologies

As a Deaf psychologist, I spend a lot of time reflecting upon how best to work with members of marginalized communities of all types.  Some of my clients are Deaf, some identify as trans*, and some are both.  And within both of those communities, similar tension exists around the issue of what it means to claim that particular cultural label. 

For many younger trans* individuals, gender is a fluid, socially constructed idea, not a biological one.  Those who identify as genderqueer or genderfluid often resist any form of binary gendered label.  Men can wear dresses and still be male.  Women can walk around in combat boots and red lipstick.  An individual can be male sometimes and female at other times or even a third gender that consists of a blend of both.  Indeed, turning traditional ideas about gender on end is one of the goals of the movement.  Under this philosophy, those who wish for a complete physical and social transformation are, in essence, supporting the status quo: a status quo that many gender non-conforming people find oppressive and hurtful.  Those who used to be oppressed have, post-transition, joined the enemy camp, so to speak.

On the other hand, many transgender individuals who have suffered silently for years are desperately happy to be able, finally, to walk down the street without fear.  Attracting unwanted attention may have previously resulted in discrimination, harassment, pain, or violence.  For those individuals, being able to access transition services in order to feel at home in their bodies and in the world has been a tremendous blessing.  And so the tension continues, between competing ways of viewing one’s own relationship to the social justice movement at large.

Similarly, within the Deaf community, there has long raged a debate about whether choosing a surgical intervention to improve one’s hearing is simply an accommodation to a world that does not sign, or if it represents victory of the oppressors.  Hearing people, by and large, view deafness as a sensory deficit to be remedied in any way possible.  Deaf culture views deafness as a unique way of existing within the world.  Deaf culture revolves around fluency in American Sign Language and an appreciation for Deaf art, history, and society.  For those who value Deaf culture the way that any other minority group values its own culture, choosing to get a cochlear implant as an adult is considered submitting to the oppressive tyranny of the majority.  Why cut one’s head open when there is nothing inherently wrong with being Deaf?

For other Deaf adults, a cochlear implant is simply a tool, much like a hearing aid.  It improves ones hearing, potentially, but it does not alter identity as a Deaf adult.  And so the tension continues to exist.  For both groups, the stakes feel high, for the opposing choice seeks to negate the one that each individual has made.  I wonder, however, if this is perhaps how movements advance.  All social justice movements thrive on tension and change.  Each subgroup forces the other to articulate their stance more clearly, to explain it to others, and to attempt, at least politically, to find common ground.

Contributed by Dr. Mel Whalen

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The Sound of One Hand Clapping

I am reminded of this ancient Zen koan when speaking to a person who doesn’t fit neatly into our binary ‘gender’ boxes.  And I try to keep it at the forefront of all that I do to serve the needs of gender variant people and their families.

As you’ll recall, the sound of one hand clapping is silence.  That is, the absence of sound.  Why the absence?  Because there is no resistance, no other hand to create a barrier against which the sound is created.

Gender variance is like this.

The ‘sound’ of feeling something other than ‘masculine’ or ‘feminine’ is only created because outsiders create a barrier.  That is, a child just feels how they feel.  We label it as appropriate, or not, depending upon how neatly the child’s feelings fit into our expectations, i.e. whether the child’s behaviors hit the ‘barrier’ of what we expect to see.

Confused yet?

Indulge me for a minute here, and consider a 3-year-old child.

The child feels feminine, loves activities we associate with little girls, colors we associate with female, the frilliness that Madison Avenue has taught us is ‘girly’.  This is one happy little kid, waking up each morning with energy and enthusiasm and readiness for whatever the day will bring—and for a 3-year-old, just being alive is a very exciting adventure.  Few 3-year-olds worry, or are anxious or depressed (thank goodness).

Enter Stage Right: Adult

The adult looks at this happy child, judges the child to be male or female (female, in this case), and treats the child accordingly.  Unless, of course, the adult is one who is intimately connected with the child, like a parent, or a doctor.  Then the adult might note the child’s physical body, and be concerned if there are body parts we associate with masculinity.

Once the dichotomy is noticed, it is usually not ‘unnoticed’ and the child begins to be treated differently.  In some families, the child continues to grow up happy and content and comfortable. In other families, the child is taken for evaluation to a doctor or psychotherapist to figure out what is ‘wrong’.

Incongruent Are Us

We might say the child is ‘gender incongruent’. Incongruence, as defined by Collins, is ‘the quality of being surprising because out-of-place; oddness’. But remember our story so far—the child isn’t surprised, nor feels odd.  The child just has feelings. Any incongruence is caused by adults who are uneasy with the mismatch between how the child feels and what expectations adults have for the child based upon the child’s body parts.

Wow, This Sounds Familiar

Who among us—having grown to a height out of range as ‘expected’ for our sex—hasn’t been asked many times “Do you play basketball?”  If I had collected spare change every time I’d been asked that growing up I might have been able to retire by now.

Remember the really bad old days, when your athletic ability was expected to correlate with your race? Or your cooking and cleaning ability was expected to correlate with your reproductive organs?  Sure, it sounds wrong and even silly now.  And may it ever be so.

What I’m suggesting is that the ‘wrongness’ of gender identity is external to an individual’s experience.  Any ‘wrongness’ is in our society, in our staunch determination to fit people into neat little boxes, and our unwillingness or discomfort when we can’t.

Here at the gender program, I’m watching the trends. Hang on to your hats, friends.  The world is changing, because we now know the truth.

It isn’t about them.  It’s about us.

And society needs to transition.  Right here.  Right now.

Great Expectations

Parents are often referred to as ‘expecting’ when a baby is on the way. Plenty of meaning in that phrase! So as we head into the season honoring those who raised us with their own expectations (Mother’s Day and Father’s Day) it makes me ponder what expectations are all about and how they influence us.

What do we expect of ourselves and others? What do we hope to accomplish as we move forward through life? And for transitioning people, what is expected before, during, and after transition?

Flower_reflectionMirror, Mirror

I am often told by a gender variant client that what they see in the mirror is not how they feel inside…or conversely, that what they see in the mirror is not what others see when they look at them.

Both viewpoints can be a double-edged sword. It can be very positive to see beyond an ‘imperfect’ self. On the other hand, the converse of this is what eating disorders and other body dysmorphic disorders are rooted in—an inability to see accurately what is reflected.

Reflections in the mirror are also based upon the belief that what we look like is who we are—appearance trumping all other characteristics. Given that we live in a society that judges people solely by physical attributes—skin color, height, weight, apparent age, physical abilities, etc.—I think that we’ve all fallen into the same trap to varying degrees, and it can be extremely limiting.

Boy ClothesDenimjeans

Is clothing gendered? Can you tell a boy sock from a girl sock just by looking? While we’re on the topic, why is it that girl’s and boy’s shirts button on opposite sides? Wouldn’t it make more sense to have left-handed clothing and right-handed clothing? And by the way, why don’t the clothing manufacturers ever ask my opinion?

Seriously, what does it mean to buy clothing of the ‘other’ gender? Given that gender is a social construct—academic-speak for ‘we make this stuff up’—how in the world have we come to infuse clothes with feminine or masculine meaning?

All those guys during the Renaissance period wearing tights and tunics—were they transgender? And what about the robes worn by many religious leaders today, not a trouser to be seen—are all those people transgender? What about women who wear jeans found in the men’s department because they fit better—are those women transgender? Or the new style of ‘skinny’ jeans worn by both men and women—are all those people transgender?

Perhaps clothing only takes on gender-meaning if we make it so…using external appearance to announce something about ourselves that has meaning for us, and therefore, everyone else too. Maybe we use clothing to judge others—to try to fit them into the neat categories we develop to make us less anxious about the real, true, ambiguous world.

My Point, and I Do Have One

Working with transitioning people means helping them manage their own expectations. ‘After’ transition (whatever that means for the individual) how will they look to others? How will they look to themselves? If they’ve spent years hiding their birth sex, will they now flaunt their destination sex? If so, will they look as different to those who love them as they think they look, or want to look? What if they don’t? How will they incorporate their destination gender into their real lives, because life doesn’t stop while one is transitioning?

Most importantly, will the life-long hatred of one’s birth sex and all the markers of it, lead to the same self-loathing, but just from the other side—such as, ‘I’m not girly enough’ or ‘I’m not manly enough’.

For all of us, it would be worthwhile to spend some time exploring just what it means to be girly, manly, or in-between…a more gender-fluid culture would expand options for everyone.

Agree? Disagree? Let me know what you think.

For Everything There is a Season

As a psychotherapist and program director assisting gender-variant people, I’m often urged to evaluate and recommend for hormone initiation quickly. Quickly, as in, ‘I can’t wait any longer; I’ve been waiting my whole life’.

Sometimes this pressure comes from other therapists working with clients, making it even more challenging—here I am, slowing down a process which involves two other people without having any first-hand knowledge of the situation myself.

It’s All Relative

Thinking of the various pros and cons of our program’s three-month evaluation period for new patients requesting hormone initiation, I developed the following timeline to illustrate some relative timing for crucial (or at least interesting) life events:

A baby learning to walk 12 months
Replacing 100% cells in human body 11 months
Gestating a human 9 months
One year of public education 7-8 months
Driver’s Education (Michigan) 6 months
One college semester 4 months
Evaluation for Hormones 3 months
Average annual television viewing 2 months
Average annual Internet usage 2 weeks
Slow-cooking a pot roast 8 hours
Watching a televised college game 4 hours

 

Faster Than a Semester in College, Slower Than a Pot Roast

For a gender-variant person, initiating hormones can be a significant event that demonstrates forward motion. It is similar to the experiences of coming out to family and friends, beginning to live as one’s destination gender, looking into legal name changes, and dealing with the inevitable questions. Starting hormones is a moment in time to be marked—it is technically the physical beginning of transition.

To rush the stage prior to hormones is to lose some important transition experiences. There is a unique quality to the social and emotional transition period which will never return once hormones are underway.

Similar to early childhood years, when life is fresh and new and exciting every single day, pre-medical transition is infused with the sweetness of ‘firsts’—the first time one is referred to by correct pronouns…the first time Mom uses one’s newly chosen name…the first trip outside dressed in the right clothes…the first time looking into the mirror and seeing the person one is meant to be.

Simply put, these experiences are not to be missed. They are an important part of one’s transition narrative, and to skip them in a rush to hormones is to lose something very, very precious.

That is why we recommend three months, and that is why I hope all transitioning people and their therapists will agree.

“The longer the waiting the sweeter the kiss”…it is a lovely tune, and an important message.

International Day of Social Justice

Golden Lady Justice, Bruges, BelgiumSo how was your International Day of Social Justice? Ahh, what’s that you say? Never heard of it? Okay…let’s see if we can get you up to speed here. After all, in celebrating it we renew our focus on the idea that, as the United Nations puts it, “social development and social justice are indispensable for the achievement and maintenance of peace and security within and among nations….” Certainly a worthy idea, so let’s take a quick look.

There is an entity called the International Labor Organization (ILO) that actually has its roots in the treaty that ended the First World War, the Treaty of Versailles. Now given the fact that the world had just fought what was, at least up until that point, the most blood-soaked and resource consuming war ever known, and given that all this came about because of concentrated power in a few inflexible minds; the Great Powers decided a more democratic rethink was perhaps in order. It was agreed that true peace can only exist if there is a climate of social justice and that would mean guiding the world toward a system that was far more inclusive than many had seen before.

It was indeed a lofty ideal and they did such a bang-up job of implementing it that, 20 yearsThe_Big_Four,_Paris_peace_conference later, another planet wide conflagration would rage out of control. Yet maybe that’s what happens when the ideas are broader than those trying to implement them. Versailles was simply the beginning of a social evolution that they started and continues to this day. Now I doubt they understood the full magnitude and reach of their work as somehow I have trouble picturing David Lloyd George and straight-laced Woodrow Wilson pounding the table and demanding a clear path for a future Christine Jorgenson to do the first M to F transition. But their declared spirit of social justice did exactly that and it is the spirit of that ideal that needs to carry on.

This writer is just one beneficiary of it. I’m one transwoman knocking around in a much larger but still inclusive society. I am still very much in transition and yet when I arrived for jury duty the other day, no one so much as batted an eye. I took my place among all the other “choral whiners”, belting out such ballads as “other fish to fry today” and of course the ever popular “it’s cold out why am I here?” blues. I wasn’t selected to sit on a jury that day but I did go up to the window and ask to edit the M/F designation on the sheet they had me fill out. The woman at the window looked at me and said, “Oh don’t worry about it.” Now that, dear reader, is the spirit of social justice. I am one person, from one group, and I am proof that as society grows ever more inclusive, respect for human worth grows with it.

Balanced_scale_of_JusticeNow of course, the job is a long way for done especially when we look globally. So in the hope of keeping this evolution alive, the United Nations General Assembly unanimously declared that, starting in 2009, February 20th will annually be celebrated as the World Day of Social Justice. It is the common folk everywhere that have shouldered the burdens to attain it while also reaping the benefits of it, so why not commemorate and celebrate? Embodied in this little known day, are the spirits of Gandhi and Dr. King. Indeed, the whole ongoing and bone jarring drive toward equality for women, gays and the transgender found footing because of social justice. It is the driving force that created the world wide climate that ended apartheid in South Africa and made it possible for a very brave woman named Aung San Suu Kyi to stand up to a military dictatorship in Myanmar, formally Burma, and win the Nobel Peace Prize in the process.

It is a shame that this really big day receives so little notice and especially by the common folk it was designed to further the most. After all, it was a healthy respect, if not an outright fear, of the common folk that motivated the ideas’ founders in the first place. No doubt it has something to do with a complete lack of any vested commercial interests that starves the day for any air time. Nobody has made it a day to frolic in the beer suds and pound down piles of tasty, if unhealthy, eats. But ya know???? If that’s all it takes…maybe grabbing a beer, buns, and brats ain’t all that bad an idea….

Out With It

Hello! I am Martha Compound and I have been honored with an offer to contribute my own experiences about “coming out” as transgender. I will also tell the reader that I am about a year into my M2F transition. Of course, the opinions and views expressed here are my own and nobody but myself is responsible for them. I offer the following with the hope it does some good somewhere.

Before I go any further here I want to mention that I am happily married. I had told her about this little dilemma of mine way back at our beginning. I love her dearly and she loves me. She has walked every step with me and she has watched me tear myself to pieces over the years, struggling with it. She has watched me cry, cried with me and even cried for me. Equally, she has genuinely reveled in my successes. When I made the decision to do something about it, her words were “it’s about time” and then stood right there to face everyone else with me. She is my soul mate. As I evolve, we get even closer. She is a gift. And now my story…

I remember walking into my doctor’s office for a regular checkup. It was the first time I had decided to wear feminine apparel out in public with the specific intent of telling the world that I am not a man but am instead a transgender woman. I was beyond nervous and I knew it showed. I was in that same panicky moment I had found myself in way back when I was a very small child in the mid 1950’s. I was also at the same fork in life’s little road caused by my girl parts not being present. Just like then, I had to either choose to risk being dismissed as an irrelevant fool because I couldn’t prove my brain sex or live through the mechanisms of imposed masculinity. Having already paid a very dear price for taking the masculine fork the first time through, I had no intention of repeating that same mistake. So with my heart half in my throat, we entered my doctor’s office, determined to stand my ground, come what may. The nurse took maybe half a second to drink me in and yet took my vitals without missing a beat. She carried on like nothing out of the ordinary was happening. It was indeed a rather surreal moment. Then the doctor came in and politely asked me what’s going on? I couldn’t hold it back anymore. I was on the verge of a mini-meltdown and with my eyes beginning to flood, she looked at me, and in a sympathetic voice said, “The outside doesn’t match the inside, does it?” I managed to nod an agreement and then felt the tempest that had been building in my head during the drive over, finally begin to ebb. Oh I wasn’t calm by a long-shot, but I knew I had just taken my first steps on the other fork. Hiding the truth was no longer optional and strangely enough, that was a comfort. I knew that was the most uncomfortable I would ever be. Being public got a little easier everyday thereafter.

Now beyond shaving close and wearing female garb, I had done little to otherwise alter my appearance, save for the long hair I’ve had for decades. Having crossed the “its out now” threshold, the size and depth of the social factors came rushing to the forefront. I had announced that I was going to follow my brain sex and not my body’s sex. But that also meant risking the same blow-back I feared the last time around at this same fork. That, of course, being taken for an irrelevant fool as opposed to a woman. I think that idea is what bothered me the most.

I’m someone who abhors asking for help in matters this personal. It didn’t take long, though, before I realized that I really did need help. I had the physical aspects of gender reassignment to deal with and even bigger still was the job of somehow figuring out how to integrate well over 50 years of living as the wrong sex and denying the right one. If nothing else, checking to confirm that I was not “confused” also seemed prudent. So, while diddling around on the Internet, I bumped into something called the “Comprehensive Gender Services Program” at the University of Michigan Health System. Fearing that I was not going to measure up or would otherwise end up being told I was nuts, I had to really push myself to dial the phone. On my first call, an answering machine picked up. I panicked and hung-up. Then I got mad at myself for chickening out and so I dialed again. This time a woman with a strong, confident and yet reassuring voice answered. They call what followed an intake interview yet somehow the word conversation seems more accurate. I had never met the woman on the other end but somehow I felt like we were just gabbing over coffee. It was right then and there that my actual evolution began in earnest and started to gather some momentum. So for anyone contemplating reassignment, it’s a very wise call to make. Speaking strictly about myself, they didn’t take control and dictate, but rather played sounding board and consultant to ensure that I was in control. Shortly thereafter, I was ready to get the “telling everyone else” phase over with.

I briefly toyed with the idea of calling everyone, but as I thought about having all those very clunky conversations, I decided that perhaps the US Postal Service offered a more practical solution. Phone calls might still happen (and indeed did) but at least the ice would already be broken. So in a letter to all, I tried to keep the emotion out and give a nuts and bolts briefing on what I was doing. I briefly explained the mechanics of how brain and body sex can biologically differ and also how I was under professional care. I also kept a number of copies in my purse to hand out to people who have known me for years, like the folks at our neighborhood pharmacy. It’s just too clunky of a conversation to have over a store counter. I might also mention that after I offered them this letter their faces seemed far more at ease when dealing with me. I don’t see them for long, but I do see them often.

Well, in very short order, a card came back with a very pretty butterfly on it from a close, out-of-state family member addressing me as Ms., and containing a declaration of unconditional love. Equally, a local family said, “I believe you, you should know”. I think the biggest relief came when my wife’s eldest son called and rather matter o’factly said, “I’ll bet you feel a lot better now don’t you?” Family was like that and I love them all for it.

All that were left were friends. My career kept me away from home far more than at home. Because of that, all my friends lived far away. I liked to think of them more as event pals or job buddies. We’d spend many months on a job and then completely drop out of each other’s lives, however thick we were during the job. Even so, there were still a handful that were fun to touch base with. Like keep a running email exchange or an occasional phone call with. Sadly, I figured I would lose all of them but as they were still good people, it was well worth a shot anyway. Well, before I could act, I suddenly ended up with about a two-week stretch where all those guys decided to out of the blue, give me a call! I mean people I hadn’t heard from in over two years. Well, their surprise was palpable but then came statements like “you do what you need to do to be comfortable with yourself”! Or “You’re my friend, do what you gotta do! Ya really think it matters?” Now I confess that contact with most of them is softening, but that has everything to do with lives just moving on and nothing to do with ostracizing. I don’t do that job anymore as the big economic meltdown of ’08 forced me into early retirement.

As transgender, I’ve had to stand at a particular fork in life’s road that most people don’t. Yet many, many people face other forks that have forced equally tough “lesser evil” choices with all the social difficulty mine posed. Fortunately, the world is a much more inclusive place now than it was the first time I stood at my fork. I thank all those who deliberately pushed inclusion as a key global-wide value. February 20th. is the “International Day of Social Justice”. It’s a little known day, but I mark it by noting the difference in societal attitudes regarding transgender inclusion between my two trips to my fork. I also celebrate the inclusion of countless other groups as we accept the diversity that is humankind. Now to be sure, the job of inclusion is by no means done, yet the inclusive evolution does continue.

Thanks,

Martha

Informed Consent…and Thoughtful Consideration

NOTE: The opinions expressed here are only the writer’s, Nancy Quay, LMSW.  They are not meant to reflect any official statement from the University of Michigan Health System (UMHS) or the UMHS Comprehensive Gender Services Program (CGSP).

Informed Consent for Medical/Surgical Treatment

The Informed Consent model of care, growing in popularity and availability in the transgender health world, is based upon a common assumption that individuals can be—in fact, should be—responsible for their own healthcare decisions.  It is a medical model that grew throughout the 20th century, in part caused by legal action taken by patients against physicians.

An excellent article on informed consent was written by Hana Osman in 2001 and I encourage you to read it.  It is critical that we understand the history as we embrace change within the practice of transgender healthcare.

Informed consent for transgender patients is currently in practice in many places, and is being debated in others.  There are many arguments in favor of gender-variant people having access to the medical and surgical care that will bring them into congruence and enhance their lives.  The recent and appropriate shift from ‘Gender Identity Disorder’ (placing the problem within the patient) to ‘Gender Dysphoria’ (placing the problem within society) is an indication that the field of transgender healthcare is a rapidly evolving landscape.  Personally, I applaud many of the changes and also the larger conversation about the importance of serving the needs of our transgender citizens.

So where is my hesitation?

Addressing the Binary

The issue of binary genders is often brought up in discussions of gender variance.  Having only the choices of male/female, masculine/feminine, and boy/girl is restrictive, and robs many people of the freedom to live more fluidly.

But here’s what catches my attention—in the 16 years I’ve worked as a social worker and psychotherapist with transgender people, while many of my clients have commented on the restrictions of binary gender, those same people have moved from one end of the spectrum to the other.  That is, people assigned male at birth have become women; people assigned female at birth have become men.

See the problem?  It is still a binary designation, they’ve just moved from one side to the other, most usually with the help of medicine and/or surgery.

Do we live in a binary world?  Absolutely.  Gender is seen that way but there are other dichotomies as well—adult/child, teacher/student, therapist/client, doctor/patient, Republican/Democrat, and many more. 

The REAL Binary

However, I believe the real binary category is between SELF and OTHER…that these designations are the foundation of all other binary categories.  For example, the designation between ‘self’ and ‘other’ is the basis for many of the wars fought around the globe.

You are you.  I am me.  To you, I am the other.  To me, you are the other.

And therein is my personal issue with the model of informed consent for gender transitions.

There is No Vacuum

No one, NO ONE, transitions in a completely ‘other’ free environment, even transgender people who have no family, no close friends, no employer, etc.

We live in society.  We are surrounded by ‘others’ all the time.

All of us have ‘others’ in our lives.  It might be the person who walks his dog by our house and knows our dog, even if he doesn’t technically know us.  If we transition and change in looks or behavior, he will notice.  It might be the mail carrier, who notices our name change.  Perhaps it’s the grocery clerk who notes a change in our appearance and maybe even a change in what we buy to eat.

Does it matter?  Maybe, maybe not.

But the trouble with the informed consent model is that the question—does it matter? — is never asked.

What is asked?  Well, here are a few: are these medications safe for me?  Can I tolerate any side effects?  Do I understand the risks?  Am I prepared to take the medications on a regular basis?  Am I taking full responsibility for the effects of these medications on my body?

Too many people, daunted by the prospect of explaining their gender concerns to others, feel that medical and/or surgical transition will force acceptance.  That is, if one doesn’t want to hear dad’s disappointment, mom’s fear, or sister’s distress, just don’t tell them until after breasts develop, or voice deepens.  It will still be a battle, but the outcome will be pre-ordained, all of the good, but also all of the bad.

Informed consent allows this to happen.

Without a chance to talk to a professional—someone with no vested interest in one’s answers who has heard hundreds of stories from transitioning people—what about the other questions?

For instance: am I prepared emotionally for the change in my appearance? Am I prepared socially for how that might change my status in the world? Am I prepared for negative reactions to the changes, which may affect my job security, my social life, or my emotional and physical safety?

These are crucial questions.  A transitioning person who has limited or no opportunity to explore the full ramifications of their physical and emotional changes with a caring and supportive professional is at risk for negative outcomes.  And I don’t believe that is anyone’s goal.

Thoughtful Consideration

The informed consent model, with all of its strengths and weaknesses, is here already.  If it isn’t in your neighborhood, it will be soon, and in many, many ways transgender people will benefit from it if they are within the care of knowledgeable and compassionate medical providers.

But I encourage everyone—providers, patients, caring ‘others’—to thoughtfully consider all the ramifications of gender transition, not only for the person experiencing it but for society at large.

If we are to offer this service to our transgender citizens, we must also offer everyone else a chance to learn and grow about gender variance in a non-judgmental environment.

It won’t be achieved by forcing ‘others’ to accept the new ‘self’.   And it won’t be achieved by implying that gender transition is trivial, or doesn’t matter.