Elizabeth and Jude were far from the first to receive professionally-administered gender-affirming care. Even before Christine Jorgensen’s highly publicized transition in the 1950s, there were Magnus Hirschfield’s operations in the 1920s-30s on Dora Richter, who was the first known person to receive a gender-affirming vaginoplasty.

Elizabeth and Jude have both gone on to live long, fulfilling lives. They, alongside OUTWORDS’ other transgender elders,⁷ are case studies in an argument that is quite simple to many trans people: Medical transition is essential healthcare. It’s not new; it’s as safe and legitimate as any branch of medicine; and for many, it saves lives.

The Diagnostic and Statistical Manual, or DSM, is a compendium of all psychiatric diagnoses – and a living document that has evolved over time. The first and second editions of the DSM, which were published in 1952 and 1968 respectively, did not mention gender identity at all; the DSM-III added the diagnoses “Gender Identity Disorder of Childhood (GIDC)” and “transsexualism” in 1980; the 1994 DSM-IV combined the diagnoses into “gender identity disorder”; and the 2013 DSM-V (the most recent DSM) replaced the diagnosis with “gender dysphoria.”

With the diagnosis “gender dysphoria,” simply being trans stopped being a “disorder” on paper; the DSM-V even explicitly states that “gender non-conformity is not in itself a mental disorder.”¹² However, dysphoria – the distress that can result from having one’s gender vary from their sex assigned at birth – remains classified as a disorder.

As transgender healthcare has evolved, so have the regulations defined by organizations to ensure that every patient gets the appropriate care for their needs and is protected from potential malpractice. WPATH, or the World Professional Association for Transgender Health (formerly known as the Harry Benjamin International Gender Dysphoria Association, formed in 1979), establishes standards of care and ethical guidelines to ensure that transgender healthcare continues to be safely practiced and well-researched.

“Professionals need to be less fearful,”¹⁶ author and advocate Jamison Green¹⁷ says, reflecting on his time as on WPATH’s board of directors from 2003 to 2011 and then as president from 2014 to 2016. Jamison suggests that gender-affirming healthcare providers see their roles less as “gatekeepers” and more as helpers. “Stop trying to put brakes on people and start trying to help them,” he says. “Your role is to say, ‘How can I help you be more comfortable in your gender?’”¹⁸

Educator and activist Marcus Arana¹⁹ notes the double standard between the same procedures for cisgender and transgender people: “People do body modification in all sorts of ways all the time and they are not asked to get letters from psychologists,” he points out. “You can get nose jobs, you can get your ears tucked, you can get your breasts enhanced – unless you’re a transsexual woman, then you can’t get your breasts enhanced unless you get a letter from a psychologist.”²⁰

“What people still don’t understand is that trans people are not trying to deceive people,” Jamison Green says. “We are not trying to be something we are not. We are actually trying to be our authentic and actual true selves, no matter what that looks like.”²¹

But what about those who come to regret their transition? It’s a common refrain from sources of anti-trans misinformation, cherrypicking rare cases of transition-related regret and making them out to be an overwhelming majority. This flies in the face of the true data: the regret rate for gender-affirming surgeries²² is less than 1%, while multiple²³ studies²⁴ demonstrate²⁵ the positive impact of gender-affirming healthcare, including improved mental health outcomes.

Former WPATH president Dr. Marci Bowers²⁶, a gynecologist and gender-affirming surgeon who has performed more than 2,500 gender-affirming vaginoplasties, points out the regret rates for other, more common procedures. For instance, some studies²⁷ cite the rate of regret for total knee replacements being 20% or greater, and breast augmentations have a regret rate²⁸ of up to 9.1%. “But they’re not out there campaigning to outlaw breast implants,” Marci says. “You don’t formulate a policy based on case reports of bad outcomes.”²⁹

The existing research on healthcare for trans minors includes a landmark study³² of 70 patients in an Amsterdam clinic receiving puberty suppressants, where patients at the average age of 13.5 had significantly lower behavioral and emotional difficulties as time went on after their treatment. A follow-up study³³ assessed 55 patients who switched from puberty suppressants to hormone treatments at the average age of 16. After 5 years of hormones and 1 year after surgery, these patients demonstrated equal or greater well-being than a cisgender control group. And, a 2022 study³⁴ indicated a 40% decrease in depression and suicide attempts for adolescents between ages 13-17 receiving gender-affirming hormone treatment.

Conversely, The Trevor Project reports that in 2025, trans and nonbinary youth who were unable to access the hormones they wanted were nearly twice as likely to attempt suicide, compared to those who could access the hormones.³⁵

Two words that come up repeatedly in conversations about trans youth are “phase” and “trend,” both of which Aidan Key is familiar with through his work with families of transgender young people. Many parents ask him, “What if they change their mind?” Concerned parents are understandably afraid that their child may be influenced by their peers, and want them to make the best long-term choices.

“Okay, so how do you know?” Aidan asks. “You don’t.” Instead, he offers a different way forward: “What’s going to help your children the most is to hear them.”³⁷ (This statement is supported by the data: The Trevor Project’s 2025 survey³⁸ shows a decrease in suicide attempts for trans and non-binary youth with gender-affirming homes.)

Starting hormone replacement therapy was a difficult choice for Aidan, who had spent his life pre-transition identifying as a butch lesbian. However, he found stability in understanding that transitioning was not as all-in as he’d previously believed, and that the only way to know if it was right for him was to try. “Certainty is a crystal ball,” he says, “and I don’t have one.” For him, it was the right decision in the end: Roughly a year into taking testosterone, Aidan looked in the mirror and said, “‘There you are.’ That’s the person that I expected to see looking back at me my entire life.”³⁹

That doesn’t mean that life after transition is going to be perfect. One major stressor for trans people who medically transition can be the healthcare establishment itself. Yoseñio Lewis⁴⁰, a trans health activist and educator who has experienced more than his fair share of medical neglect and injustice, speaks to the difficulty that comes with being visibly transgender in healthcare settings.

“Every single medical thing that happened to you subsequent to you beginning your physical transition [is] attributed to your physical transition,”⁴¹ Yoseñio says, referring to an emergency room visit where medical providers asked whether his pneumonia might be the result of taking testosterone.