Sarah J. Rogers

Personal Essays

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Gender Affirming Care Saved My Life

Sarah Joni Rogers

At the age of 59, I was hospitalized for suicidal depression. I had been depressed since childhood, despite an ostensibly good life, including the love of two grown children, close friends, and a successful career as a physics professor. After describing my suicide plan to my therapist, she directed me to terminate our video session and drive myself to a local emergency room. I now realize that my life turned around at that moment.

Medical scientists believe that gender identity — an internal sense of self as male, female, or other — has, like sexual orientation, three interrelated biological causes: genetics [1], brain structure [2], and in utero hormonal exposure [3].  About a third of the 1.4 million transgender Americans are trans women like me, who identify as female but were assigned male at birth, and another third are trans men — people who identify as male but were assigned female at birth [4]. The remainder, called nonbinary, identify as a mixture of male and female, neither, or others. Studies show [2] that trans women have brains resembling those of non-trans women, while trans men have brains that are similar to non-trans men. Because of its biological origin, gender identity is durable and inextinguishable. It is not a matter of choice [5] or psychiatric illness [6], and it very rarely changes [7]. I know this: I struggled against my gender identity for most of my life, and had I been able to change it by resolve alone, mine would now be male.

Transgender identities — an umbrella term that includes trans men, trans women, and nonbinary people — lead to a mismatch between body and mind that for many can be soul-killing. Nearly all trans individuals I have met say they have experienced prolonged depression, known as gender dysphoria, during their lives. Most trans high schoolers (72% [8]) experience significant feelings of sadness or hopelessness and about a quarter (26% [8]) attempt suicide. The suicide rate of trans people overall is almost eight times higher than the general population [9]. Gender dysphoria often emerges at a young age, sometimes even by age 7 [10]. There are only two effective medical treatments: gender affirming hormone therapies, which involve estrogen, testosterone, and blockers of these, and gender affirming surgeries. Gender dysphoria is also nearly always improved (say 94% of trans people [11]) by socially transitioning to live in alignment with one’s identity. In my own experience, all three (hormones, surgery, and transition) are remarkably powerful and have utterly transformed my life. I have not encountered any other effective behavioral or medical remedies despite 30 years of psychotherapy and world-class medical care.

I started hormone therapy with estrogen after leaving the hospital, and I was stunned by its effectiveness. Over the decades, I had tried dozens of antidepressant medications, as well as more radical treatments for depression like electroconvulsive therapy and transcranial magnetic stimulation, and none came close to what I felt after only a single day from a tiny dose of estrogen. Although some people experience mood changes that have a purely chemical origin, the effectiveness of hormone treatments usually stem from a feeling of gender affirmation, and a sense that one’s body is in greater alignment with one’s identity. Affirmation and alignment are also behind the efficacy of transgender surgeries and social transition. 

Hormone therapies in trans youth are very uncommon (1 in 20 [12]) and surgeries are extremely rare (1 in 50,000 [13]). They are a last resort for young people with severe depression. To give trans kids more time to decide on next steps and alleviate the intense distress that can arise from the physical changes caused by puberty, they are normally first prescribed puberty blockers. If the blockers are discontinued, puberty will resume with the same outcome. Doctors therefore consider these blocking medications to be reversible [14]. Studies have shown [15] that hormone blockers, hormones, and surgeries greatly improve depression, anxiety, body discomfort, and quality of life. They are the medical gold-standard treatments for gender related depression and are supported by every major medical association in the U.S. Fewer than 1% of trans patients have regrets from these treatments (0.3% [16]), and I have yet to meet a single one. 

While some individuals may experience a decrease or fluctuation in their dysphoria, it frequently persists throughout life. In the case of trans youth, one medical team writes [17]: “For most children with GD [gender dysphoria], whether GD will persist or desist will probably be determined between the ages of 10 and 13 years [18] although some may need more time [19].” A UK study [20] spanning 2008-2021 of over 1,089 youth who medically transitioned found that only 5.3% stopped treatment and identified with their sex assigned at birth. A 2022 Dutch study of 720 trans youth [21] who initiated hormone therapy reported an even smaller discontinuation rate (2%). The authors write: “Most participants who started gender-affirming hormones in adolescence continued this treatment into adulthood. The continuation of treatment is reassuring considering the worries that people who started treatment in adolescence might discontinue gender-affirming treatment.” These findings differ from older research that, due to weaker diagnostic criteria and methodological shortcomings, suggested gender incongruence in childhood often resolves during adolescence.

Medical treatments for gender dysphoria in teens are very rare. Across the U.S. in 2021 [22], over 42,000 youth aged 6-17 received a gender dysphoria diagnosis, yet only 1,390 received puberty blockers, 4,231 were prescribed cross-sex hormones, and only 282 had chest surgeries. But despite the rarity and effectiveness of such treatments, they have been banned in 27 states [23] containing 40% of the 300,000 trans teenagers in the U.S. These policies, implemented with the urging of the federal government [24] and the approval of the Supreme Court [25], have led to significant increases in suicide attempts among trans youth — 38% to 44% increases across ages 13 to 24, and up to 72% for those under age 18 [26].  Similar restrictions have been implemented in many European countries pending more “definitive evidence” [27].

Such policies irresponsibly magnify the tiny chances of regret and greatly discount the likely harms from withholding treatment. This is particularly misguided in the case of puberty blockers, because these medications only temporarily pause pubic changes — changes that I dream about reversing every day, but no longer can. Were the discussion about any other type of medical intervention with a similar risk/reward ratio, I doubt there would be serious debate about whether the treatment should be made available. 

As a parent, I would be terrified by any chance of regret in my child, no matter how small. But there is no other choice if self-harm is realistically possible. It is therefore vital that these treatments remain available, for both youth and adults. It is also critical to discuss gender-related issues in schools and at home, without which many trans kids will grow up, as I did, without an acceptance or understanding of themselves. Suicide prevention programs for LGBTQ people, the federal support for which has now been terminated [28], can also be lifesaving.  As one staffer at a suicide hotline for trans youth and adults said [28]: “Ultimately, the children whose stories of trauma and isolation I listened to had only one question. It was a simple one: Who can I turn to?”

1. Foreman, M., et. al., Genetic Link Between Gender Dysphoria and Sex Hormone Signaling, Journal of Clinical Endocrinology & Metabolism, Volume 104, Issue 2, February 2019, pp 390-396, https://doi.org/10.1210/jc.2018-01105

2. Kurth, F., Gaser, C., Sánchez, F., Luders, E., Brain Sex in Transgender Women Is Shifted towards Gender Identity, J Clin Med. 2022 Mar 13;11(6):1582. doi: 10.3390/jcm11061582

3. Roselli CE. Neurobiology of gender identity and sexual orientation. J Neuroendocrinol. 2018; 30:e12562. https://doi.org/10.1111/jne.12562

4. Herman, J., Flores, A., O’Neill, K., How Many Adults and Youth Identify as Transgender in the United States?, Williams Institute, UCLA, June 2022

5. Transgender Health, www.endocrine.org. 16 December 2020, https://www.endocrine.org/advocacy/position-statements/transgender-health

6. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, American Psychiatric Publishing, pp. 685-705, ISBN 978-0-89042-555-8

7. Kristina R. Olson, Lily Durwood, Rachel Horton, Natalie M. Gallagher, Aaron Devor; Gender Identity 5 Years After Social Transition. Pediatrics August 2022; 150 (2): e2021056082. 10.1542/peds.2021-056082

8. Disparities in School Connectedness, Unstable Housing, Experiences of Violence, Mental Health and Suicidal Thoughts and Behaviors Among Transgender and Cisgender High School Students — Youth Risk Behavior Survey, United States, 2023, CDC Morbidity and Mortality Weekly Report (MMWR), Supplements / October 10, 2024 / 73(4);50-58

9. Erlangsen, A., Jacobsen A.L., Ranning, A., et al., Transgender Identity and Suicide Attempt and Mortality in Denmark, JAMA. 2023;329(24):2145-2153. doi:10.1001/jama.2023.8627

10. Zaliznyyak et. al., How early in Life do Transgender Adults Begin to Experience Gender Dysphoria? Why This Matters for Patients, Providers, and for Our Healthcare System, Sex Med. 2021 Oct31;9(6):100448.doi:10.1016/j.esxm.2021.100448

11. James, A., et. al., Early Insights: A Report from the 2022 U.S. Transgender Survey, Feb 2024

12. Hughes, L., et. al., Gender-Affirming Medications Among Transgender Adolescents in the U.S., 2018-2022, JAMA Pediatric. 2025;179(3):342-344.doi:10,1001/jamaperdiatrics.2004.6081

13. Day, D., et. al., Prevalence of Gender-Affirming Surgical Procedures Among Minors and Adults in the U.S., JAMA Network Surgery Research Letter, JAMA Network Open. 2024;7(6):e2418814.doi:10.1001/jamanetworkopen.2024.18814

14. Puberty blockers for transgender and gender-diverse youth,  Mayo Clinic website 2025: https://www.mayoclinic.org/diseases-conditions/gender-dysphoria/in-depth...

15. Schmidt, L., Levine, R., Psychological Outcomes and Reproductive Issues Among Gender Dysphoric Individuals,  Endocrinology and Metabolism Clinics of North America Volume 44, Issue 4, December 2015 , pp. 773-785, doi: 10.101016/j.ecl.2015.08.001.

16. Regret Rates for Transgender Surgery are Practically Non-Existent, GenderGP, October 2024

17. Kaltiala-Heino R, Bergman H, Työläjärvi M, Frisén L. Gender dysphoria in adolescence: current perspectives. Adolesc Health Med Ther. 2018 Mar 2;9:31-41. doi: 10.2147/AHMT.S135432. PMID: 29535563; PMCID: PMC5841333.

18. Steensma TD, Biemond R, de Boer F, Cohen-Kettenis PT. Desisting and persisting gender dysphoria after childhood: a qualitative followup study. Clin Child Psychol Psychiatry. 2011;16(4):499–516. doi: 10.1177/1359104510378303. 

19. Steensma TD, Cohen-Kettenis PT. More than two developmental pathways in children with gender dysphoria? J Am Acad Child Adolesc Psychiatry. 2015;54(2):147–148. doi: 10.1016/j.jaac.2014.10.016.

20. Butler G, Adu-Gyamfi K, Clarkson K, El Khairi R, Kleczewski S, Roberts A, Segal TY, Yogamanoharan K, Alvi S, Amin N, Carruthers P, Dover S, Eastman J, Mushtaq T, Masic U, Carmichael P. Discharge outcome analysis of 1089 transgender young people referred to paediatric endocrine clinics in England 2008-2021. Arch Dis Child. 2022 Oct 19;107(11):1018-1022. doi: 10.1136/archdischild-2022-324302. PMID: 35851291.

21. van der Loos MATC, Hannema SE, Klink DT, den Heijer M, Wiepjes CM. Continuation of gender-affirming hormones in transgender people starting puberty suppression in adolescence: a cohort study in the Netherlands. Lancet Child Adolesc Health. 2022 Dec;6(12):869-875. doi: 10.1016/S2352-4642(22)00254-1. Epub 2022 Oct 21. PMID: 36273487.

22. Respaut, R., Terhune, C., Putting numbers on the rise in children seeking gender care, Reuters, Oct. 6, 2022, https://www.reuters.com/investigates/special-report/usa-transyouth-data/

23. Ghorayshi, A., Harmon, A., Federal Report Denounces Gender Treatments for Adolescents, The New York Times, May 1, 2025

24. Nirappil, F., Youth gender transition care criticized in HHS report that conceals authors, The Washington Post, May 2, 2025, https://www.washingtonpost.com/health/2025/05/01/trump-transition-care-t...

25. Liptak, A., Supreme Court Upholds Tennessee Ban on Transgender Care for Minors, The New York Times, June 18, 2025

26. Lee, W.Y., Hobbs, J.N., Hobaica, S. et al. State-level anti-transgender laws increase past-year suicide attempts among transgender and non-binary young people in the USA. Nat Hum Behav 8, 2096–2106 (2024). https://doi.org/10.1038/s41562-024-01979-5

27. Block, J., Gender dysphoria in young people is rising—and so is professional disagreement, BMJ 2023;380p382 doi: https://doi.org/10.1136/bmj.p382 

28. Astor, M., Trump Administration Will End L.G.B.T.Q. Suicide Prevention Service, The New York Times, June 18, 2025

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Why Am I Transgender?

Sarah Joni Rogers

One of my earliest life memories was my disappointment that I was born a boy. I was only about 6 or 7 years old, raised by kind but preoccupied parents along with two much older siblings — a brother and a sister. I was an anxious, tentative, and sad child — until recently a lifelong introvert — and had only a handful of playmates, both boys and girls. I liked being with the girls better.

Studies have shown that gender dysphoria often onsets at such early ages [1]. In my case, as in most others [2,3], it lasted into adulthood and steadily worsened with each decade. But I was raised in the 60’s and 70’s, when the word “transgender” was not commonly known, let alone the concept of gender identity as distinct from sex assigned at birth. So as a child I had no idea what my gender-related thoughts and feelings could possibly mean. I supposed that all boys might secretly wish they were girls, though I was too ashamed to ask. I insisted on wearing my hair as long as my parents would allow and felt a secret thrill when strangers — as they often did — mistook me for a girl. My favorite toy of all-time was a pink baby carriage. The other boys sensed this lack of masculinity and I was tirelessly bullied.

As I got a little older, I started having a recurring dream in which I find myself riding in an open car, dressed in a scarf and sunglasses, miraculously transformed into a woman, and I am overcome with amazement and joy. My feelings are so strong that I aways wake up at that point — the dream, repeated dozens of times, has never gone any further — only to realize it was just a dream. Instantly, my mood swings from joy to depression like an anchor sinking to the bottom of the sea.

As with sexual orientation, nearly all medical scientists and doctors now regard gender identity — a sense of self as male, female, or other — to be a biological trait [4-6]. Gender identity and sexual orientation are both spread across a spectrum of possibilities and are as unique to each person as one’s anatomy or temperament. We are thus apparently all born with a template of male and female and are innately attracted to — and associate ourselves with — one sex, the other, both, or neither. Sexual identity and orientation, being biological, are durable and inextinguishable. They are there when we wake up and when we go to sleep, day after day, year after year. When a person’s gender identity and assigned sex do not match, the relentless internal and social disconnect can be soul-killing. My experiences as a transgender woman differ in detail from my trans friends, but we share one thing in common: a feeling that our gender identity does not fit our bodies. This is the source of gender dysphoria, and in my case and many others, it was very nearly fatal.

I have long been confounded by the personal importance of my gender. A person’s assigned sex derives from the details of one’s anatomy, which evolved mindlessly over eons to facilitate the propagation of our species. I feel like the essence of who I am should transcend the details of my sexual biology, as well as the categorization of my gender by society. But it does not. The incongruity of my identity and body has been the source of persistent depression. Though gender affirming care has helped enormously, I have never fully resolved the inner dissonance caused by this mind/body inconsistency, nor do I expect I ever will.

There are three proven remedies for gender dysphoria — hormone therapies (which include blockers of testosterone and estrogen), gender affirming surgeries, and social transition to live in alignment with one’s identity. In my experience, all three are remarkably powerful and have utterly transformed my life. It would be cruel to deny anyone the chance to follow a similar course.

Efforts to eliminate a person’s biologically assigned gender identity will not make it go away. It is doing trans kids a harmful disservice to suppress discussion or exploration of gender-related facts and ideas in schools and at home. Teaching kids about such concepts will not change their identity from what it always has been, and what it always will be. Rather than protecting young people, withholding frank discussion causes great damage, because it forces trans kids to somehow discover the meaning of their feelings on their own. This process will be made all the harder if transgender identities are rejected categorically by their caregivers and society. They will be forced to grow up, as I did, without an understanding or acceptance of themselves. They may have to unnecessarily endure many years gender-related depression and confusion. They may eventually be brought— as I was — to the threshold of choosing oblivion over life.

So, why am I transgender? I am because I was born that way. It is not a matter of choice but of fate. When we transition, we do so because living inauthentically is even worse than the persecution we face in society. In the end, for most of us, it is the only path to happiness — a path that every person in the world deserves to follow in peace.

1. Zaliznyyak et. al., How early in Life do Transgender Adults Begin to Experience Gender Dysphoria? Why This Matters for Patients, Providers, and for Our Healthcare System, Sex Med. 2021 Oct31;9(6):100448.doi:10.1016/j.esxm.2021.100448

2. Kaltiala-Heino R, Bergman H, Työläjärvi M, Frisén L. Gender dysphoria in adolescence: current perspectives. Adolesc Health Med Ther. 2018 Mar 2;9:31-41. doi: 10.2147/AHMT.S135432. PMID: 29535563; PMCID: PMC5841333.

3. Butler G, Adu-Gyamfi K, Clarkson K, El Khairi R, Kleczewski S, Roberts A, Segal TY, Yogamanoharan K, Alvi S, Amin N, Carruthers P, Dover S, Eastman J, Mushtaq T, Masic U, Carmichael P. Discharge outcome analysis of 1089 transgender young people referred to paediatric endocrine clinics in England 2008-2021. Arch Dis Child. 2022 Oct 19;107(11):1018-1022. doi: 10.1136/archdischild-2022-324302. PMID: 35851291.

4. Foreman, M., et. al., Genetic Link Between Gender Dysphoria and Sex Hormone Signaling, Journal of Clinical Endocrinology & Metabolism, Volume 104, Issue 2, February 2019, pp 390-396, https://doi.org/10.1210/jc.2018-01105

5. Kurth, F., Gaser, C., Sánchez, F., Luders, E., Brain Sex in Transgender Women Is Shifted towards Gender Identity, J Clin Med. 2022 Mar 13;11(6):1582. doi: 10.3390/jcm11061582

6. Roselli CE. Neurobiology of gender identity and sexual orientation. J Neuroendocrinol. 2018; 30:e12562. https://doi.org/10.1111/jne.12562

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Trans Athletes Should Be Allowed in Women’s Sports

Sarah Joni Rogers

A controversy ignited when a transgender girl — a person who identifies as female but was assigned male at birth — on the track team of the 700-student Greely High School in Maine won a class B pole-vaulting event. State Rep. Laurel Libby (R-Auburn) made the next move, posting on her official Facebook webpage the name, photos, and other details of the trans student. Within days, the Feb. 17, 2025 post went viral in conservative media and had over 42,000 comments. The Trump administration has since pulled all federal K-12 education funding from the state. “We’re getting what feels like hatred from high-ranking people in the government, and it’s coming down on kids who don’t really have much power and say,” said Cora Berry, 16, a sophomore on the Greely track team [1].

Few people, if any, object to transgender males — people who identify as male but were assigned female at birth — competing with boys and men. Rather, the debate is about trans girls and trans women in female sports, and whether such participation is safe and fair to non-trans (“cisgender”) females. The issues depend on the age of the athletes, the sport in question, and — in the case of elite sports — hormone regulations.

Puberty leads to greater average size, weight, strength, and speed, particularly in males and trans females. The simplest case therefore concerns prepubescent trans girls younger than about age 12, or those who have had puberty medically blocked (less than about 1 in 20 trans girls [2]). Doctors and researchers agree [3,4] that for this age group there is no physical reason to prohibit combined trans and cisgender (non-trans) participation in sports. The sizes and abilities of these kids are not significantly different and, if anything, favor cisgender girls, who undergo puberty about 1.5 years sooner than trans girls.

Trans girls generally experience puberty in high school, during which they undeniably develop, on average, athletic advantages, including greater size and speed. It is understandable that some parents are concerned that these larger and faster kids might pose an added safety threat on the playing field. But there is no evidence that trans competitors cause more injuries to their cisgender counterparts [5,6]. Data from hospital admissions, on the other hand, does show the opposite: trans girl athletes are almost twice as likely to be injured by cisgender girls (25.4% vs. 14.7% [7]).

At the level of high school, the question of fairness is more subjective. The degree of competitiveness varies greatly, and for most students, the goals are not about winning, but health, enjoyment, and teamwork. But at any level, it is crucial to balance concerns about fairness with the serious psychological harms that come from excluding trans kids from playing sports with their friends. Almost half (40% [8]) of trans high schoolers report bullying, most (72%) suffer significant feelings of sadness or hopelessness, and about a quarter (26%) attempt suicide. Most trans kids understandably avoid sports participation — for example, among my home state Maine’s 2025 high school sports population of nearly 50,000 students, only 2 were trans [9]. In my opinion, the risks of psychiatric distress for this tiny population supersede fairness considerations.

At the elite level, the participation of trans athletes in female sports (when it is permitted) usually requires years of prior testosterone suppression. Trans female athletes who have had such hormone therapy must propel a larger frame and greater weight without the offset of added strength and endurance from testosterone. A recent review [10], echoing a previous finding by different authors [11], looked at all relevant studies about trans women in elite sports from 2011-2021 and concludes: “Available evidence indicates trans women who have undergone testosterone suppression have no clear biological advantages over [cisgender women] in elite sport.” The best laboratory analysis done to date [12] was commissioned by the International Olympic Committee (IOC) and was published in 2024 in the British Journal of Sports Medicine. The authors write: “These results…suggest that transgender women lack lower body anaerobic power compared with the other groups” and “when normalized for fat-free mass, transgender women’s peak power was lower than that of cisgender women.” They also report: “compared with cisgender women, transgender women have decreased lung function,” “[trans women] performed worse on the countermovement jump” and the “cardiovascular fitness [of trans women] is lower than [cisgender men] and women.” The authors conclude: “…these results should caution against precautionary bans and sport eligibility exclusions that are not based on sport-specific (or sport-relevant) research.”

Trans athletes are very rare. Of the roughly 500,000 students in the 2024 NCAA, only about 10 were trans, and of the 300 competitors on Team USA in the 2024 Olympics, there was only one trans member — runner Nikki Hiltz, who finished seventh place in the 1500 m. Only about five transgender women have ever reached the championship level of elite sporting competitions worldwide [13]. Practically speaking, the activism directed against trans participation would be better spent on greater support for female athletics.

Most people do not appreciate the rarity of trans female athletes and are unfamiliar with existing data about bodily injury in youth or the impacts of testosterone suppression in adults. Given this lack of information, many Americans (79% [14]) genuinely disapprove of trans women and girls participating in female sports. But in the case of K-12 trans girls, at least, trans exclusion will in fact protect nobody, while the exclusion of trans youth from sports is causing unquestionable harm. Contrary to the claim that the bans are about protecting kids, they are in fact having exactly the opposite effect.

1. Kingkade, T., How one Maine high school became the center of Trump's war on trans student athletes, NBC News, April 10, 2025, https://www.nbcnews.com/nbc-out/out-politics-and-policy/maine-high-schoo...

2. Hughes, L., et. al., Gender-Affirming Medications Among Transgender Adolescents in the U.S., 2018-2022, JAMA Pediatric. 2025;179(3):342-344.doi:10,1001/jamaperdiatrics.2004.6081

3. Tennessean, E., et. al., Performance development in adolescent track and field athletes according to age, sex and sport discipline, PLoS One, Published online June 4, 2015:1-10. Doi:10.1371/journal.pone.0129014

4. Safer, J., Fairness for Transgender People in Sport, J Endor Soc., Volume 6, Issue 5, May 2022, bvac035, https://doi.org/10.1210/jendso/bvac035

5. GenderJustice, https://www.genderjustice.us/toolkits/trans-inclusion-sports

6. City of San Francisco, California, https://www.sf.gov/trans-women-in-sports-facts-over-fear

7.  Study Exposes High Injury Rates in Transgender Women,  Radiological Society of North America, press release on December 4, 2024

8. Disparities in School Connectedness, Unstable Housing, Experiences of Violence, Mental Health and Suicidal Thoughts and Behaviors Among Transgender and Cisgender High School Students — Youth Risk Behavior Survey, United States, 2023, CDC Morbidity and Mortality Weekly Report (MMWR), Supplements / October 10, 2024 / 73(4);50-58

9. Moore, E., Trump administration says it is suing Maine over transgender athletes in girls' sports, NPR,  April 16, 2025, 

https://www.npr.org/2025/04/16/nx-s1-5366648/trump-justice-department-ma...'%20Association%2C%20MPA,at%20least%20three%20transgender%20athletes.

10. Transgender Women Athletes and Elite Sport: a Scientific Review, Canadian Centre for Ethics in Sport, 2021

11. Jones, B.A., Arcelus, J., Bouman, W.P. et al. Sport and Transgender People: A Systematic Review of the Literature Relating to Sport Participation and Competitive Sport Policies. Sports Med 47, 701–716 (2017). https://doi.org/10.1007/s40279-016-0621-y

12. Hamilton, B., Brown, A., Montagner-Moraes, S., Comeras-Chueca, C., Bush, P., Guppy, F., Pitsiladis, Y., Strength, power and aerobic capacity of transgender

athletes: a cross-sectional study, Br J Sports Med, 10 April 2024. 10.1136/bjsports-2023-108029

13. Veronica Ivy — winner of the 2018 world masters cycling championship, Lia Thomas — winner of the 2022 N.C.A.A. Division I national championship in free-style swimming, JayCee Cooper — winner of the women’s 2019 national championship for bench press in the super heavyweight division, Michelle Dumatesq — winner of the 2003 Canadian National Championships in downhill mountain biking, and Austin Killips — winner of Mexico’s 2023 Tour of the Gila cycling event

 14. New York Times/Ipsos survey, 2025, https://static01.nyt.com/newsgraphics/documenttools/f548560f100205ef/e65...

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Conversion Therapy Harms Kids

Sarah Joni Rogers

Transition to live in society in alignment with one’s gender identity — female in my case — separates one’s life into what came before and what came after. The life trajectory of my mood has been shaped like a “V.” The downslope represents steadily worsening gender dysphoria as my former male personal Barrett, which had started in childhood and progressed despite a wonderful family and career. The ascent reflects my post-transition transformation into the happy, joyful and more confident person — Sarah — that I am now. The bottom of the V — the low point of my life — was a hospitalization for nearly ending my life at the age of 59. I almost succeeded with that plan.

Medical scientists believe that gender identity — an internal sense of self as male, female, or other — and sexual orientation have three interrelated biological causes: genetics [1], brain structure [2], and in utero hormonal exposure [3].  About 14 million people in the US, including 2 million youth, identify as lesbian, gay, bisexual, or transgender [4]. Roughly a third of the 1.4 million transgender Americans [5] are trans women like me — people who identify as female but were assigned male at birth, a third are trans men, and a third are nonbinary. Gender identity and sexual orientation, because they are biologically determined, are durable and inextinguishable. They are not a matter of choice [6] or psychiatric illness [7], and they very rarely change [8]. I know this: I struggled against my gender identity for most of my life, and had I been able to change it by effort and resolve alone, mine would now be male.

Conversion Therapy — a practice that is legal in nearly half of US states [9] and soon likely to be legalized elsewhere by the Supreme Court [10] — is based on the fallacy that people can choose to alter their gender identity or sexual orientation. Some adherents of conservative religious traditions suggest that trans people can “learn to love the body that God gave them,” or that gay people should pray for “deliverance from homosexual desires.” But perceived gender and sexual preference, like them or not, are biologically hard-wired in transgender and gay people from birth. They are an unalterable consequence of the “body God gave them.” Almost all doctors now consider them both to be medically normal variations of our species, as unchangeable as the color of our eyes. When therapists, doctors or priests suggest that they can be changed or suppressed by force of will or faith, they doom their LGBTQ patients and congregants to failure, guilt, frustration, and depression.

This has been shown by definitive scientific evidence. One recent study [11] of more than 4,000 LBGTQ youth found that those who underwent conversion therapy were more than twice as likely to report having attempted suicide in the past year compared to those who did not, and more than 2.5 times as likely to report multiple suicide attempts. A recent large study led by Stanford researchers published in The Lancet Psychiatry [12] confirmed the link between conversion therapy and significant mental health issues, including Post-Traumatic Stress Disorder (PTSD), depression, and suicide. Such evidence has led to an overwhelming consensus among mainstream medical and psychological institutions — including the American Medical Association, American Academy of Pediatrics, American Psychiatric Association, National Association of School Psychologists, American Psychoanalytic Association, and American Counseling Association — that conversion therapy is ineffective and harmful and should be banned for minors. A 2020 report from the United Nations [13] described conversion therapy as potentially amounting to “torture.”

It can be challenging for traditional religious organizations, political institutions and conservative caregivers to rapidly adjust their views to factual evidence that is relatively recent and not yet broadly appreciated. But it is essential that they do so, because without their support, our LGBTQ youth will grow up, as I did, without an understanding or acceptance of themselves. These young people may even be brought to the threshold of hopelessness, as I eventually was, and turn to the final option to end their pain.

1. Foreman, M., et. al., Genetic Link Between Gender Dysphoria and Sex Hormone Signaling, Journal of Clinical Endocrinology & Metabolism, Volume 104, Issue 2, February 2019, pp 390-396, https://doi.org/10.1210/jc.2018-01105

2. Kurth, F., Gaser, C., Sánchez, F., Luders, E., Brain Sex in Transgender Women Is Shifted towards Gender Identity, J Clin Med. 2022 Mar 13;11(6):1582. doi: 10.3390/jcm11061582

3. Roselli CE. Neurobiology of gender identity and sexual orientation. J Neuroendocrinol. 2018; 30:e12562. https://doi.org/10.1111/jne.12562

4. change: Conron K, LGBT Youth Population in the United States, September 2020, The UCLA Williams Institute

5. Herman, J., Flores, A., O’Neill, K., How Many Adults and Youth Identify as Transgender in the United States?, Williams Institute, UCLA, June 2022

6. Transgender Health, www.endocrine.org. 16 December 2020, https://www.endocrine.org/advocacy/position-statements/transgender-health

7. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, American Psychiatric Publishing, pp. 685-705, ISBN 978-0-89042-555-8

8. K. Olson, Lily Durwood, R. Horton, N. Gallagher, A. Devor; Gender Identity 5 Years After Social Transition. Pediatrics August 2022; 150 (2): e2021056082. 10.1542/peds.2021-056082

9. A. Harmon, More Than 20 States Have Banned Conversion Therapy for L.G.B.T.Q. Minors, Oct. 7, 2025, The New York Times

10. J. Jouvenal, Supreme Court sharply questions law banning conversion therapy, Oct. 7, 2025, The New York Times

11. Trevor News, New Study Finds Conversion Therapy, and its Associated Harms, Cost the U.S. an Estimated $9.23 Billion Annually, The Trevor Project, Mar. 7, 2022

12.  Tran, Nguyen K. et al., Conversion practice recall and mental health symptoms in sexual and gender minority adults in the USA: a cross-sectional study, The Lancet Psychiatry, Volume 11, Issue 11, 879 - 889

13. United Nations Report, A/HRC/44/53: Practices of so-called “conversion therapy” - Report of the Independent Expert on protection against violence and discrimination based on sexual orientation and gender identity, May 1, 2020

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Aggression, Dominance and Testosterone

Sarah Joni Rogers

I have always been a pacifist. When I was compelled to register for the draft in the 1980’s, I did so — to the outrage of my father, a WWII pilot — as a conscientious objector. I am very slow to anger and have never raised a hand against anyone in my life.

I am also a transgender woman — a person who identifies as female but was assigned male at birth. Like my lack of aggression, my libido has always been usually low — a serious problem in my two failed marriages — likely due in part to my low baseline testosterone levels. These levels are normally about 30 times higher in men than in women [1], and mine are far below that. 

Testosterone stimulates muscle growth, greater strength and sex drive that, particularly during early human evolution, was crucial for defense, survival and reproduction. It is also fundamental to the arousal of brain structures involved in aggressive behaviors and sex-drive. Human behavior, like the structure of our brains, is complex. There are wide variations across individuals, societies, and time periods. The temperament of every person is unique and depends on many environmental and biological variables. Testosterone does not directly cause any individual behavior, but rather has a more subtle, facilitative role. 

That said, the vast majority of physical assault — including violence toward transgender and gay people — is perpetrated by cisgender (natal) men rather than women. In 2019 [2], most of nationwide arrests (79%) for violent crimes and nearly all arrests (88%) for homicides were men, who comprise the bulk (93% [3]) of the inmate population in federal prisons.

Aggression originates in the core of the human brain, also called the “animal brain” because it is shared alike by all animals. This core was the first to evolve, and includes the limbic system — mainly, the hypothalamus and amygdala, which are the source of fear, anxiety, and anger. The impulses of the animal brain are partially regulated by the outermost brain layer, the cerebral cortex. This layer is responsible for more sophisticated cognitive abilities like language, abstract thinking, emotional regulation, impulse control, and social awareness.  Our brains will thus, by their segmented design, always involve a competition between savage instinct, emotion, social restraint, and abstract reasoning.

Aggression and dominance in modern humans are atavistic behaviors — reversions to ancient ways of thinking or acting that were once important but in present times may no longer be as useful. In many species, dominance — particularly in males — is the most biologically and reproductively salient goal, and aggression is its pathway. Although such behaviors were once essential, they now produce excessive violence in our families, societies, and the world.

Studies have shown [4] that testosterone levels are higher in individuals that exhibit aggressive behavior, such as prisoners who have committed violent crimes. Studies have shown [5] that testosterone is higher among subjects with aggressive personality or antisocial conduct. Neuroimaging in adult males has demonstrated [4] that testosterone activates the brain’s main aggression center (the amygdala) and heightens its resistance to restraint from the cerebral cortex. The importance of testosterone for aggressive behavior has also been underscored by animal castration experiments. A combined analysis [6] including many animal studies concludes: “Results overwhelmingly indicate that testosterone and aggression are related.”

Atavistic residues of male dominance and aggression pervade our cultures and societies. They are reflected in our militaries, governments, and religious doctrines, which until recently were almost exclusively controlled by men. Men’s natural instinct to aggressively assert dominance has helped perpetuate male power structures.

While women’s bodies also produce testosterone and female aggression is not uncommon, both are much less pronounced than in men. One would hope that the increasing prevalence of women decision makers will gradually reduce military aggression and war. Unfortunately, the goal of greater gender equality is likely to take a long time: women were not granted the right to vote until 1920 (fifty years after Black men), the Equal Rights Amendment has yet to be ratified by the required number (three-quarters) of states, and female reproductive rights were overturned by the Supreme Court in 2022. The progress of women has been slow because our laws, governments, and institutions are still largely governed by men, who were raised in a male-dominated culture and are often disinclined to share authority with women.

One author [7] writes: “Matriarchy emphasizes shared power, collaboration, and nurturing relationships, moving away from hierarchical dominance seen in patriarchy. This shift towards a partnership-oriented society aims to dismantle oppressive structures and promote collective well-being, benefiting both women and men alike.” That sounds like an antidote to many of the problems we now face in our society — and it can’t happen soon enough.

1. Mount Sinai 2025 website: mountsinai.org/health-library/tests/testosterone

2. Crime in the U.S. 2019, FBI data, Table 42: Arrests by Sex, 2019

3. Federal Bureau of Prisons — Statistics: Inmate Sex, 2025, https://www.bop.gov/about/statistics/statistics_inmate_gender.jsp

4.  Batrinos, M., Testosterone and Aggressive Behavior in Man, In J Endocrinol Metab. 2012 Jun 30;10(3):563-568. doi:10.5812/ijem.3661

5. Stanton, S., et. al., Dominance, politics, and physiology: voters’ testosterone changes on the night of the 2008 United States presidential election, PLoS One. 2009;4(10):e7543. doi: 10.1371/journal.pone.0007543

6.  Book, A., et. al., The relationship between testosterone and aggression: a meta-analysis, Aggression and Violent Behavior, Volume 6, Issue 6, Nov-Dec 2001, 579-599

7. Peluso, C., Ending The Patriarchy: A Pathway to Equality and Regeneration, Population Media Center, May 14, 2024

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What Does It Mean to be Nonbinary?

Sarah Joni Rogers

“Kamala is for they/them, President Trump is for you.” This Republican slogan from the 2024 presidential race featured the pronouns preferred by many of the 1.2 million transgender Americans [1] who identify as nonbinary — an umbrella term for identities that fall outside the man/woman binary, including mixtures of male and female, neither, and others. Nonbinary people are comparable in number to trans individuals who identify as men (trans men) or women (trans women) — the so-called “binary” transgender identities. They can have either male or female birth-sex assignments and, like all transgender people, can have any sexual orientation. The broadest, most inclusive gender descriptor for all trans people is “gender-diverse.”

Nonbinary people are the least commonly understood and least scientifically studied type of trans identity. They are the most diverse group but are usually lumped (as in this essay) into only one category. They prefer an array of pronouns, including they/them, he/him, she/her, and “neopronouns” like xe/xem or ze/hir. I am a transgender woman and prefer she/her, and I have a nonbinary trans child who was assigned female at birth who prefers they/them or he/him — anything but she/her. Although most trans people are not touchy about honest mistakes, when in doubt it is usually best to ask rather than guess based on a person’s appearance.

In their most common usage, the terms “transgender” and “cisgender” are mutually exclusive: a person may identify as either one or the other, but not both. Cisgender people identity as their sex assigned at birth while transgender people do not. One would expect this to be true for nonbinary individuals, who comprise a sub-category of transgender identities. But in surveys, more than half (58% [2]) of all nonbinary adults say they also identify as cisgender, while less than half (42%) say they are transgender. Apparently, many nonbinary people feel that their gender identity also aligns with their assigned sex.

Many nonbinary individuals are less visibly trans than trans men and women. Their identities encompass a wide range of expressions, some of which are understated or gender neutral. Many (67% [3]) desire a presentation that is more androgynous or fluid. In contrast, trans men and trans women usually undergo more overt transitions that produce more noticeable changes.

Like other transgender people, nonbinary individuals often experience gender dysphoria but tend to do so in unique ways. Most (71% [3]) feel there is “no solution.” Distress can be caused by overtly male or female characteristics (height, voice, etc.) that seem too masculine or feminine compared to how they feel inside. Agender people, who do not identify with any gender, are the least likely to feel that their experiences of dysphoria are well captured by established clinical scales [4].

Gender dysphoria in nonbinary people is addressed medically using the same methods applied to other transgender people. There are fewer guidelines, however, and the efficacy of various treatment options are less clear [5]. About half of nonbinary individuals (40%-55% [4]) are receiving, have received, or desire gender affirming hormone therapy. The prevalence of surgeries is much lower (9% [6]) than in trans men (54% [7]) or trans women (28% [7]). The most common reason [3] for not seeking surgery among nonbinary people is “not needing it for my transition.” Studies have emphasized the importance of a personalized clinical approach [8].

Nonbinary gender identities are as deserving of recognition and respect as all other types, transgender or cisgender. All trans individuals share the conviction that their identities do not fit their bodies, and like all people on earth, they simply desire to live peacefully as the happiest version of themselves. Hopefully society will eventually realize that granting this wish will cost it virtually nothing.

1. Bianca D.M. Wilson and Ilan H. Meyer, Nonbinary LGBTQ Adults in the United States, UCLA Williams Institute, June 2021, https://williamsinstitute.law.ucla.edu/publications/nonbinary-lgbtq-adul...

2. 1.2 million LGBTQ adults in the US identity as nonbinary, Williams Institute, Press Release, June 22, 2021 https://williamsinstitute.law.ucla.edu/press/lgbtq-nonbinary-press-release/

3. Galupo, M., et. al.,  ‘There is Nothing to Do About It’: Nonbinary Individuals’ Experience of Gender Dysphoria, Transgender Health. 2021 April 16;6(2):101-110. doi: 10.1089/trgh.2020.0041

4. Dijken, J., et. al., Tailored Gender-Affirming Hormone Treatment in Nonbinary Transgender Individuals: A Retrospective Study in a Referral Center Cohort, Transgender Health. 2023 Jun 1:8(3):220-225. doi: 10.1089/trgh.2021.0032

5. Tristani-Firouzi, B., et. al., Preferences for and barriers to gender affirming surgeries in transgender and non-binary individuals, Int J Transgender Health. 2021 August 12;23(4):458-471. doi: 10.1080/26895269.2021.1926391

6. Nolan, I., et. al., Demographic and temporal trend in transgender identities and gender confirming surgery, Transl Androl Urol. 2019 Jun;8(3):184-190. doi: 10.21037/tau.2019.04.09

7. Kailas, M., et. al., Prevalence and Types of Gender-Affirming Surgery Among A Sample of Transgender Endocrinology Patients Prior to State Expansion of Insurance Coverage, Endocrine Practice, Volume 23, Issue 7, 780-786, July 2017, doi: 10.4158/EP161727.OR

8. Cocchetti, C., et. al., Hormonal Treatment Strategies Tailored to Non-Binary Transgender Individuals, J Cin Med. 2020 May 26;9(6):1069. doi: 10.3390/jcm9061609

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