Listen to Transgender Youth | Opinion

The American Medical Association (AMA) is now recommending the removal of sex labels from birth certificates. Sexual identification, according to the AMA, is often arbitrarily assigned based on external genitalia, may have little to do with how someone feels about themselves and can lead to problems including stigmatization and discrimination.

As a practicing psychologist, I've worked with nonbinary, including transgender, individuals. About 10 years ago I had a patient who transitioned from female to male through hormonal treatments but without surgery. Slightly built, the only work he could find was in a warehouse, where he was routinely ridiculed, and finally forced to quit. My patient struggled with depression, anxiety and suicidal ideation. The challenges for transgender people were even more daunting than today; their issues weren't yet politically correct. The repercussions for being nonbinary—especially for being transgender—ranging from physical violence and murder, to prohibitive federal and state laws, to social rejection, can be punishing and traumatic.

What struck me was my patient's problems were generated by society's reactions to him, not by any inborn distress.

Recently discovered remains belonging to an individual who lived sometime between 1050 and 1300 A.D. suggest a person of nonbinary status. A male-bodied person was buried in traditional feminine dress. Previous archaeological findings have also raised questions about how gender was conceptualized by ancient societies. Gender fluidity has been around a long time, a lot longer than has been generally acknowledged.

"Being nonbinary isn't an invention of the 21st century," author Dianna E. Anderson said.

Deciding to transition often occurs around adolescence and the onset of puberty. Best-practice medical care for transgender youth—according to the American Academy of Pediatrics, the American Medical Association and other leading medical authorities—recommends a low-risk medical process that pauses hormonal changes until young people are old enough to make decisions about who they are.

Nearly 2 percent of high school youths identify as transgender, according to the U.S. Centers for Disease Control and Prevention (CDC). The CDC reported that more than one out of three transgendered youth attempted suicide, a significantly higher proportion than their cisgender peers. Increasingly more individuals are identifying as transgender, with the rates for Generation Z (born 1997-2002) nine times higher than among baby boomers (born 1946-1964). Whether this is a true shift in sexual orientation, or the freedom to identify as other isn't clear.

Before the end of the 19th century the terms heterosexual and homosexual didn't exist. While behaviors were identified, individuals weren't labeled or classified—or pathologized. Heterosexuality, now the standard for healthy sexual behavior, was defined by the 1923 Merriam Webster as a "morbid sexual passion" for the opposite sex.

A silhouette of two children
A silhouette of two children. Gary Hershorn/Getty Images

Our changing attitudes toward homosexuality provide an example of how the cultural imprint determines what's pathological. Until 1973, homosexuality was considered a disease, treated by psychiatrists who tried to "correct" behaviors and feelings using conversion or reparative therapy, punishing or "curing" the person out of their same sex attraction.

Conversion therapy persists, now focused on transgender individuals. Their gender identification is pathologized by the sociocultural norms of the mainstream, as well as by the psychiatric establishment. The DSM-5, the American Psychiatric Association's guidebook for describing and diagnosing mental illness, dropped "gender identity disorder" in 2013, replacing it with gender dysphoria to categorize those who feel a mismatch between their identities and their bodies. The change reflected an effort, responding to feedback, to eliminate the pathology implied by the original diagnosis, although many say that it still suggests mental disturbance.

Denying transgender youths­ their needs can be life-threatening, and contribute to depression, social isolation, self-hatred, risk of self-harm and suicidal behavior. Research reveals youths whose families support their gender identity have a "52 percent decrease in suicidal thoughts, a 48 percent decrease in suicide attempts, and significant increases in self-esteem and general health."

Undoubtedly, there are concerns that young people aren't mentally equipped to make life-changing decisions. One indication it doesn't work for everyone is some choose to de-transition, though this typically occurs early in the process, before surgery, usually among younger people. And the rates are low, averaging less than 5 percent.

Not all societies are so judgmental. In many Native American cultures, before the arrival of the Europeans, "Two-Spirit" referred to people who were gifted and revered because they embodied two spirits: male and female. The Egyptian Pharaoh Hatshepsut was depicted as male and female. Like the 1923 definition of heterosexuality, these examples highlight the irrational manner in which we determine what's healthy.

Learning from other cultures, how we define gender identity and healthy sexuality—our conclusions appear subjective. Evidence indicates societal reactions, more than choosing to transition, put nonbinary and transgender individuals at significantly higher risk for emotional disease. The AMA's recommendations acknowledge the need to amend our perspective toward those who don't follow the standard binary.

Nancy Jainchill is a feminist, practicing psychologist and a writer focusing on gender and sexual equity. Twitter: @nancyjainchill.

The views expressed in this article are the writer's own.