The New York Times ran a piece last week bemoaning the lack of data about the frequency of transgender people in the general population. There have been a number of surveys with widely contradictory results. A survey from the Williams Institute seems accepted as the most authoritative word, giving the number at about 0.3%, or three per thousand. Before that survey, a figure from Johns Hopkins University was often quoted in the media of 1 in 20,000, or 0.05%, reportedly derived from the frequency of gender surgery. A study in New Zealand found as much as 1.2% of respondents transgender, with more than twice that many reporting they questioned their gender.
We shouldn’t find these discrepancies surprising. The transgender phenomenon is notoriously hard to pin down. A woman who has transitioned, taken female hormones, and had Gender Confirmation Surgery would clearly be classified as transgender. But how about the same woman, before she even began exploring her gender? When she just saw herself simply as an unhappy man?
The reality is that obtaining an accurate count of transgender people has a number of thorny challenges:
- Hard to get objective data – Survey experts know that subjective data is notoriously unreliable. When you ask people to report information about themselves, you face biases and inaccuracies. People differ in the way they evaluate their experiences. “Are you unhappy with your gender,” could mean to one person that they’ve experienced sex discrimination, while to another it may refer to crushing dysphoria. Mild dysphoria may register as a “no” on some people’s scale and a “yes” on others.
- The incidence of self-reported transgender responses is dependent on culture – More permissive cultures will have better access to information and less stigma, so people will be more likely both to recognize their symptoms and be comfortable exploring possibilities.
- Measuring transgender prevalence is not a priority – Obtaining accurate counts is expensive. It involves contacting or processing data from a large number of people. If we momentarily accept the 0.3% number, that means to find even 3 transgender people we need to examine information about 1,000 subjects, an expensive undertaking. Government is the primary source of research money, and governments by their nature shy away from controversy. Funding research on transgender people loses out to less controversial targets for research efforts.
- Hard to pin down exactly what is meant by being transgender – If you’re trying to include anyone with gender variant behavior, your wide net is going to bring in people who have one or two crossdressing experiences. Your number will be much smaller if you’re looking at people who sought transition-related health care. Many definitions of transgender defy accurate measurement because they deal with what goes on only in people’s heads. Other, more objectively measurably definitions, such as those receiving some sort of treatment, will miss people, resulting in undercounts.
The combination of these factors means that data on how many of us there are is surprisingly difficult to obtain. Asking how many people are transgender is sort of like asking how many people are athletic. Numbers will vary widely depending on how you define your terms. Are you asking how many people consider themselves athletic, how many people have actually participated in some sort of sport, how many display above average physical abilities, etc.? The answer depends heavily on exactly what you mean by “athletic” and how you ask the question.
This is not to say that obtaining accurate counts isn’t important. If we’re going to argue that the added cost to insurance companies of transition-related care is minimal, if we are going accurately to assess the cost, benefit, and impact of transgender rights laws, if we are to put effective policies in place to accommodate transgender people in the classroom, the workplace, and the community, these tasks become much harder if we don’t know how many people are involved.
The answer you’re looking for will be different depending on how you’re using the statistic. If you’re an insurance company trying to assess the cost of including transgender pharmaceutical benefits, the number of transgender people on hormones would be most important, while the number of people who occasionally crossdress would be of less interest. However, if you were a community center designing a program for people who think they might be trans, the number of people you’re interested in would be much larger.
What we really need is an effort by demographers to bridge the knowledge gap by quantifying all aspects of the transgender experience. The absolute number of transgender people is of limited usefulness, other than as a meaningless factoid to be quoted by mainstream news articles. Far more valuable would be a breakdown of how many people can be categorized in each of the many facets of the transgender experience — closeted, exploring, undergoing social transition, medically transitioning, obtaining surgery, and everywhere in between.
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You’re right. Counting transgender people is very difficult. Part of this is because although transgender is a term that describes a broad spectrum of gender variant behavior, most people focus on and count only the most severe cases, those who have gender dysphoria, those who have sought HRT, and those who have completed GRS.
However, these are only the people who are a six on a scale of 1 to 6, essentially, those who are severely transsexual, those for whom transition is an urgent medical necessity.
However, as we know, gender dysphoria manifests itself when we are very young, and not all children who express their dysphoria have supporting parents or communities. If you were to look at a bunch of kids in kindergarten or first grade, you would notice in a class of 30 students at least one or two “tomboys” who want to play with the boys, who push, fight, and compete, and love it, win or lose. You will also see one or two “Sissies”, boys who prefer to play with the girls, with girls toys, who are quiet, and who avoid pushing and shoving, and who don’t even seem to have the instinct to fight.
This would suggest that 10-15% of the population may have a natural inclination of transgender identity. That is, they naturally identify with the opposite gender.
However, as the children get older, by second grade, you see that many of the feminine boys have withdrawn, they have been discouraged or forbidden to play with girls, and feel awkward or uncomfortable socializing with boys. They often isolate, burying themselves in books, solitary hobbies, or even solitary sports like track.
As they get even older, by 4th or 5th grade, prior to puberty, you can see them becoming more and more isolated, with the kids calling him nerd or egg-head or book-worm. They avoid social interactions by quoting factoids, trying to impress people with how smart they are. They often lack social skills.
Shortly after the onset of puberty, you can see deeper withdrawal, anxiety, and depression. Even though at this point, they won’t admit to being transgender, or wanting to be the opposite sex, they tend to become more upset as their body changes. Often, they begin to self-medicate with drugs and alcohol, rebelling against everyone and everything who has tried to force them to conform to their birth gender.
Anywhere during this “stealth mode”, they may find their own outlets. They may begin cross-dressing, and doing it with great stealth. Many will not only keep the secret from their parents, but also from their lovers and even their spouses. Not all cross-dressers are transgender, but it’s often hard to tell because their is so much fear of discovery and denial when suspected.
Some will seek out the gay community. There, they have a bit more freedom to express their feminine side, they may even find love and romance, and may enjoy being the bottom in a gay relationship. They may find that they avoid letting others touch their private parts. They may not want anyone, male or female, touching them. Some hope that they will find sexual satisfaction and that will take away their transgender desires.
Many transgender people living in “Stealth Mode” will hide ALL of their transgender feelings, telling nobody, fearing the loss of career, lover or spouse, children, social standing, community, or religious support.
Often, the self-destructive or self-sabotage behavior becomes very covert. Drinking excessively, gaining weight and no longer caring about there appearance, recreational drug addiction, or sexual promiscuity. I once called it “Suicide on the Installment Plan”
The constant stress of trying to hide our true selves, even from ourselves, takes a toll on our health as well, allergies get worse, blood pressure rises, sleep becomes more difficult, eating becomes more excessive, infections take longer to heal, injuries take longer to heal, even bruises seem to take longer.
Some transgender people need someone to open the door for them, to tell them it’s OK. Others need a bit of a push, being goaded or coerced into dressing up and looking pretty, sometimes under some pretense. They will object, but not to the feminization, rather they will focus on their fear of discovery. Once they realize they can pass, they often enjoy the experience of being one of the girls.
Others have to delay or postpone any attempt to “come out” or transition. Some wait until the kids are grown, others wait until retirement. Many will use some of their 401K savings or IRA money to fund their surgeries.