How Maryland Can Do Better for Trans Youth

By Alexandra Siebenhaar

Last Friday, the Trump-Pence administration finalized a rule allowing healthcare providers to discriminate against LGBTQ+ individuals. The horrific ruling limits how sex discrimination is defined in Section 1557 of the Affordable Care Act to only include biological sex; previously, the definition included gender identity and sexual orientation.[i] This hurts transgender folks who already experience much discrimination from doctors and who face barriers in obtaining reproductive healthcare. Now, this new rule may deny them the care they need if infected by COVID-19. The Human Rights Campaign is suing the Trump/Pence administration in response to their finalized rule.

COVID-19 is not the only pandemic that has disproportionately affected Black transgender individuals. The AIDS pandemic killed many Black queer folks in large as a result of the U.S. government’s response. Under the Reagan administration, the AIDS epidemic was neglected, mocked, and labeled as the “gay plague.” This stigmatization of sexual activity between LGBTQ+ individuals was not only prevalent in legislation, but in the sexual health education curriculum. The Reagan administration increased federal funding for abstinence-only-until-marriage education, in which the program promoted abstinence outside of a cisgender, heterosexual marriage, and gave students misinformation regarding condoms and birth control.[ii] Under the Bush administration, the program received more than $1.8 billion in federal taxpayer dollars.[iii] The patterns of conservative Christians in power have not changed in regulating the body.

In an effort to promote abstinence, the nuclear family, and their “Christian” agenda, the Trump/Pence administration rebranded the abstinence-only-until-marriage program to the sexual-risk-avoidance program.[iv] It is imperative to recognize these changes and detect how the government influences sex education programs and the perception of transgender folks (in which discriminatory polices leads to a spike of hate crimes).[1] By experiencing societal rejection through day-to-day encounters — plus an exclusive sex education — LGBTQ youth face negative sexual health outcomes known as the minority stress effect. [v] There is more research conducted with LGB youth than transgender youth and how their sexual risk behaviors are influenced by minority stress factors. [vi]

With there being mass funding for the sexual-risk-avoidance program and a lack of federal legislation, only four states in the nation mandate an LGBTQ-inclusive curriculum: California, Colorado, Iowa, Washington, in addition to Washington D.C.[vii] Maryland does not require the majority of their sexual health education to be medically accurate; however, the new 2019 framework states there must be medically accurate information given when discussing condoms and birth control. The new framework emphasizes abstinence as the best method to avoid sexually transmitted infections (STI), acquiring HIV/AIDS, and having unintended pregnancies. This practice will especially hurt transgender individuals, many of whom are having sex earlier than their cisgender, heterosexual peers. By factoring in the sexual health topics that transgender folks want taught in their own sex education classrooms, we are establishing it to be trans-inclusive.

Puberty Blockers and Hormone Replacement Therapy

Many transgender individuals experience gender dysphoria: a distress, unhappiness, and/or anxiety when their biological sex does not align with their preferred gender identity.[viii] It’s important for sex educators to stress that HIV/AIDS can spread through the sharing of needles when transgender folks are undergoing hormone replacement therapy. However, transgender individuals do not always medically transition and may only socially transition through the process of changing their names or asking folks to use their preferred gender pronouns.

Birth Control

Like puberty blockers, birth control may decrease blood flow, menstrual cramps, or stop one’s period overall. In order to make the topic of birth control inclusive for transgender youth, sex educators must teach students that one can still get pregnant even when taking testosterone or can impregnate someone else even when taking estrogen.[ix] Birth control is good for all students who wish not to face an unintended pregnancy and transgender individuals should be allowed to discover which one works best for their bodies.

STI and HIV Prevention

Many students are not sufficiently taught about condoms in sex education and, if they are, they are not taught how to use one. Research shows most transgender youth are inconsistent with wearing condoms during intercourse with their primary sexual partners.[x] If an STI is untreated or the symptoms go unseen, it can lead to HIV. A study conducted with transgender youth shows at least 30.9% of transgender girls tested HIV positive.[xi] Most transgender folks were not taught about the HIV prevention pills: pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP).[xii] Antiretroviral therapy (ART) is a medication or HIV treatment that lowers the viral load in one’s body, in which one can still continue to engage in sexual activity with their partners.[xiii] When sex educators do not teach students about these particular medications, they are denying them the right to live healthy sexual lives and may be stigmatizing HIV positive individuals. HIV prevention and treatment are crucial in order to avoid AIDS.

Masturbation, Sexual Pleasure, and Sex Toys

Sex needs to be defined not only as penile-vaginal intercourse, but also as oral sex, anal sex, fingering or hand jobs, dry humping, masturbation, sexting, using sex toys, and reading or watching porn.[xiv] By normalizing sexual pleasure and declaring sexual pleasure an essential element to sex in sex education classes, transgender youth will feel more comfortable in learning about their own sexuality. Knowing how and where to find sexual pleasure, like through masturbation, may help transgender youth tell their sexual partners what they like or don’t like, while avoiding sexual coercion. Sex toys were specifically found to help transgender folks cope with gender dysphoria (in which the mental illness can limit sexual pleasure) and to stimulate parts they may or may not have on their own body.[xv]

Healthy Relationship Building and Consent

Transgender individuals stress needing to know how to have the conversation with their sexual partners when disclosing their gender identity.[xvi] Since many transgender individuals experience sexual violence when they are children, sex educators should teach consent as early as elementary school. By, failing to teach consent, students who attend college will continue to uphold rape culture through their language and while engaging in physical and/or sexual activity. According to the Rape, Abuse and Incest, National Network (RAINN), “21% of TGQN (transgender, genderqueer, nonconforming) college students have been sexually assaulted, compared to 18% of non-TGQN females, and 4% of non-TGQN males.”[xvii] Transgender individuals or those who don’t conform to their assigned gender at birth face an additional layer of gender oppression than cisgender women under the patriarchy. Many students experience institutional betrayal when reporting incidents of sexual violence at their universities. We must build a culture where survivors are believed and where one asks for consent.

[1] With the Trump-Pence administration attacking transgender individuals through legislation and igniting white supremacy, we are seeing killings of Black transgender women more and more.

[i] Simmons-Duffin, Selena. “Transgender Health Protections Reversed by Trump Administration,” NPR, (June 12, 2020).

[ii] “A Call to Action: LGBTQ Youth Need Inclusive Sex Education,” Human Rights Campaign, (2020): 1–10.

[iii] Ibid.

[iv] Hellmann, Jessie. “Trump announces abstinence-focused overhaul of teen pregnancy program,” The Hill, (2018).

[v] Ibid.

[vi] Ibid.

[vii] Ibid.

[viii] Planned Parenthood, (2020).

[ix] Ibid.

[x] Ibid.

[xi] Sri L. Reisner, Laura Jadwin-Cakmak, Jaclyn M. White Hugto, Miguel Martinez, Liz Salomon, and Gary W. Harper. “Characterizing the HIV Prevention and Care Continua in a Sample of Transgender Youth in the U.S.,” AIDS and Behavior vol. 21, 12 (2017): 3312–3327.

[xii] Ibid.

[xiii] Ibid.

[xiv] Ibid.

[xv] Haley, Samantha G., Diana M. Tordoff, Alena Z. Kantor, Julia M. Crouch, and Kym R. Ahrens. “Sex Education for Transgender and Non-Binary Youth: Previous Experiences and Recommended Content.” The Journal of Sexual Medicine 16, no. 11 (November 1, 2019): 1834–48.

[xvi] Ibid.

[xvii] “Victims of Sexual Violence: Statistic,” RAINN, (2020).