The life expectancy of trans women is not 35 years

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Every once in a while I read an article or comment like this:

The average lifespan of trans women in the US is 35 years. Source

This number is wrong in so many ways, but many people seem to fall for it. The most viral variant consists of screencaps of this tumblr post.

User fuckallies on tumblr: 'On average, you have a 1 in 18,989 chance of being murdered A trans person has a 1 in 12 chance of being murdered The average life span of a cis person is about 75-90 The average life expectancy of a trans person is 23-30 years old 75% of people killed in anti LGBT hate crimes are poc Think about this the next time you go crying over “cisphobia” and “reverse racism”'

Every murder is a tragedy, and it is particularly sad when someone gets murdered just for being trans. That is all the more reason to get our numbers right: exaggeration doesn’t help the cause. The lifespan statistic above is absurd. There is no way that they can be true, and it is telling of our maths and science education that people believe them.

Let’s do a basic sanity check on the 23-30 years figure. If 50% of trans folks would reach the age of 60, the other half would have to be dead by age 10. But measuring “age of death of trans people” is really tricky, because a person will only enter the trans population after transition: if they die before that, nobody knows they’re trans. So realistically, all trans people that die are at least 16 years old.  If the trans people who get murdered do so at the earliest possible age (16), how many trans people can maximally reach the age of 75? Well, we solve for the fraction x:75x + (1-x)*16=35.

Does one in 3 trans people get killed over their lives? Of course not. The only place the 23-30 year figure could realistically come from is if the number described life expectancy conditional on getting killed or some other low-probability conditional.

Media reporting

Most journalists aren’t good with numbers. This effects their propensity to cite the low life expectancy for trans folks. The Guardian:

a 2014 report concluded that the average life expectancy of trans women in the Americas is between 30 and 35.

NPR:

“Transgender people have an average life expectancy of about 30 to 32 years,” Balestra says.

Huffington Post:

The statistic said the average life expectancy for a trans woman of color is 35.

The difference is striking. “transgender people”, “trans women in the US”, “trans women in the Americas”, “trans women of colour”. They’re all misreporting the same in number in different messed up ways.

The first popular English medium to cover the number, and the source that most chains of web pages end up on, is Washington Blade, which reports one realistic number and also the unrealistic one.

The commission indicates 80 percent of trans murder victims in the Americas during the 15-month period were 35 years old or younger. Its report further concludes the average life expectancy of trans people in the Western Hemisphere is between 30-35 years.

Washington Blade cites a report by the Inter-American Commission on Human Rights of the Organisation of American States (press release, report). The report mentions this

According to the data collected in the Registry of Violence, eighty percent of trans persons killed were 35 years of age or younger.

The data (xlsx, Spanish) contains 770 reports of violence against LGBT people from a lot of countries in the Americas, all incidents happened in the 15 months between January 1st 2013 and March 31st 2014. Not all countries are in the dataset and no skin colours of the victims are listed, but are. Some victims are deadnamed, others appropriately named. Searching the names online, there are indeed a lot of trans women of colour among the listed US victims.

The data contain 282 murders on trans people, of which 212 have an age of death attached. The average age of death among those 212 is 28.7. Among 14 murder cases in the US, all trans women, the average age was 29.8. Filtering the America-wide data for listed ages of murder of 35 and under, we find 168 cases, and 168 out of 212 is 80%. This is the source of the 80% vs 35 years claim, but keep in mind that this is as a fraction of cases that have ages attached to them.

Where does the life expectancy of 30-35 years come from? The IACHR report just says this:

In terms of the age of the victims, the IACHR notes that while it seems gay men of all ages are targeted, in the case of trans women, it is mostly younger trans women who are victims of violence. In this regard, the IACHR has received information that the life expectancy of trans women in the Americas is between 30 and 35 years of age.

No source is listed. I’m calling bullshit. There is no way that getting murdered reduces life expectancy by at most 5 years.

Section of doubt

The 1 in 12 murder rate up top is interesting because it cannot be refuted in a conservative street-fighting calculation.  The US has 325 million citizens and a life expectancy of 79 years, so every year roughly 4.1 million US citizens die. If 1 in 40000 people is trans, then you’d expect 100 US trans people to die each year. 2018’s TDOR has 23 murder cases from the US listed, so we’d estimate that trans people have a 1 in 4 probability of death by murder.

I don’t trust the 1:40000 statistic within an order of magnitude, but it is an often cited one. So while I don’t take the 1:4 number to be remotely close to the truth, it is understandable if people believe the 1 in 12 figure.

On rainbow t-shirts and colleagues

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Shopping for pride t-shirts is non-trivial. Few pride t-shirts look halfway decent, and few t-shirts look good on my big man-shoulders. Imagine my delight when I found this pretty one at the Human Rights Campaign shop in San Francisco. I bought it back when I was a student a year ago, and I have been wearing it regularly ever since.

The simple student life is in the past. These days I am a PhD student, and I periodically visit conferences and workshops in various countries. One important part of these activities is to meet people and develop a professional network. I wonder, is it appropriate to wear a pride t-shirt to a conference?

On the one hand, I might not want to come out to colleagues I meet for the first time. Moreover, it might be seen as an overt political statement in an otherwise apolitical environment.

On the other hand, my field could use more queer visibility, and, most importantly, deliberately not wearing my pride shirt is also a political statement. Not an identifiably visible one, but a political statement nonetheless.

It is misguided to think anything can be apolitical. Everything is either overtly political or political by omission. The only choice is, whose politics will I adhere to? I proudly choose my own.

Heteronormativity in STEM

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There are abysmally few women in mathematics. I had taken 35 math and CS courses in my bachelor’s and master’s before I first had a woman lecturer. It makes me feel demoralised and alienated. I feel lonely when I see that nobody in my field looks like me, which makes me doubt whether research is the career for me, no matter how happy I feel when I’m working.

There are efforts to make STEM more inclusive to women. In the long run, those hopefully help to improve the gender balance in these fields. But they also help in the short term, as an occasion to meet other women in different areas who are in the same situation. Bonding over sexism is an excellent way to stave off loneliness.

Meetings on women in STEM do leave me emotionally drained for another reason: they are drenched in heteronormativity. It’s all talk about how women are giving up their academic career or working part-time because they’ve got a husband and kids and their husband earns more money or whatever the cishets are worrying about these days.

Screenshot of https://twitter.com/HITStudies/status/1045645770001698816 Heidelberg Laureate Forum @HLForum tweeted ""Behind every succesful woman stands a strong man". Anna Wienhard credits her husband and mentions this as one of the success factors in her career. The crowd applauds. Just as important: mentors, determination, decision making. #HLF18" which got retweeted by dr. Wienhards institute HITS gGmbH @HITStudies who added "We fully proudly retweet this quote by @HITStudies group leader Anna Wienhard #HLF18 @HLForum"

It is frustrating on two levels. First off, it feels like people are saying that only straight women have a place in academia. They probably don’t explicitly mean it that way, but there is a message in their language, and it is not a friendly message. Secondly, if the straight cis women’s issues were the main issues, then why are nearly all cis women in STEM straight? If 10% of the people in the field are women, but only cis women in relationships with men were getting pushed out of STEM careers, then half of all women in STEM [w]ould be LGBTQI+. [But that is not the case.]

On gatekeepers, hormones and unethical research practices?

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Background

Many, though not all, trans people who transition get hormone replacement therapy (HRT).  For transmasculine people, testosterone. For transfeminine people, estrogen and (before surgery) testosterone blockers. HRT can affect most secondary sex characteristics in a way that makes a person more comfortable with their body and helps them in being seen as their preferred gender.

For trans youth, puberty suppressing medication exists. These medications pause puberty for as long as you use it without other consequences. It is completely reversible: stop taking the medication, and your puberty will resume as if nothing happened. (All medications have side effects, but this stuff is super mild.) Puberty suppression is fantastic because it can prevent breast growth, voice deepening, beard growth and male pattern baldness, which are all expensive and time-consuming to undo after they happened. Puberty blockers are for young people who want to go on hormones but are considered too young for that, or for people that are undecided about starting HRT.

Puberty suppression medication and testosterone blockers are only legally available with a prescription in every (?) country in the world. If you want it, you have to get a medical professional to prescribe them.

Doctors have specialisations and avoid treating patients for things outside their area of expertise. That is why historically and presently you probably have to go to a specialised transgender endocrinologist to get a prescription for hormone suppression meds.

The World Professional Association for Transgender Health (WPATH) publishes a document called the Standards of Care (SoC), in which they give widely followed guidelines for medical professionals on how to best treat trans people. They say that, before medically treating an individual,  they need a diagnosis (3-12 months of counselling) and go through the hazing ritual known as the real-life experience (3+ months, no longer recommended since 2011). And not just for HRT, but also to get these puberty suppression medications. This practice is often called the gatekeeper model, in contrast to the informed consent model in which the doctor is only there to inform you of what the medications do and then gives them to you without requiring you to jump through any hoops.

Many places that treat trans people have waiting lists measured in years.

Imagine you are 14. The first symptoms of puberty start to happen, and you find out you don’t want those. Even if your parents are supportive and you can immediately get a referral from your GP, it might take two or more years before you get puberty blockers. Entirely unnecessarily, you have two years of unwanted puberty happening to you. Everyone involved knows this is unnecessary. Too bad, you’ll have to do voice therapy and laser hair removal to fix it later.

(DIY medication exists, but it is technically illegal, 95% of trans people recommends against it for reasons unknown to me, and treatment providers threaten that they will no longer help you with anything when they find out you self-medicated.)

Section of Doubt

To my best understanding, the above is a more or less accurate description of the state of affairs for many people. I consider it grossly negligent of medical professionals and policymakers to force trans people through unnecessary additional puberty, and of trans advocates that they are not making more of an issue out of this.

I do believe that people, in general, have reasons for doing what they do and believing what they believe. Considering that my view of the situation is very different from most people, I am probably missing something important. I have no idea what it might be or who is right.

Storytime

I was almost 18. I was in the process of convincing my gatekeeper/psychologist to write me a prescription for testosterone blockers. It was not going super well. I am not traditionally feminine. I didn’t desire to wear female clothing. I don’t “feel like a woman.” I wasn’t sure whether surgery would be right for me, nor whether I wanted voice therapy to sound more feminine. I just knew that I did not want any of testosterone’s further effects. I wanted HRT. I needed HRT. Only after that, I would have the time and peace of mind to think about additional steps.

I was unable to articulate the required narrative and too honest to tell the proper lie on 100% of the hundreds of arbitrary, unrelated or stereotyping questions that were supposed to measure transness. What should have been six months of counselling for getting my diagnosis, had already lasted eight months. The end was not in sight. My therapist was not planning to help me soon, not even with puberty blockers.

But then it happened. The clinic was running a scientific study on differences in brain structure between cis and trans people, and whether taking hormones affected that. They needed trans participants aged 14-19, who just started puberty blockers, to do some mental tasks in an MRI scanner, with a follow up a year or so after going on hormones. I was asked to participate in the study. If I said yes, I would get the puberty blockers and my continued masculinization would stop. If I said no, I would not start medication for months. I would probably have started growing facial hair before I would get medical help.

I felt so lucky; I immediately said yes. My body would be mine, without nature forcibly intruding on my happiness. For the first time in years, I did not want to die. I was so grateful to the researchers for letting me participate in the study. They allowed me to get my hormones.

Epilogue

This event happened over five years ago. The details might be off, but I am confident about the general outline. I am still very pleased with having HRT. I changed my name at that time as well. My old name was ugly; my new name is the best name. These days I am consistently gendered female. I’m happy about being gendered female; it saves me from a lot of transphobia and toxic masculinity.

Today, I first thought back to what happened all those years ago. Only now I realise that this story can be accurately reframed as “my doctor withheld me my treatment to force me to participate in a study”, and that ethics boards probably don’t appreciate extortion of patients. On the other hand, ethics boards do approve of the gatekeeper treatment model, so their opinion might not be the best guideline for what is good or bad. I don’t know what to think of this.

Archiving the Trans Girl Diaries

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Between standing on the shoulders of giants and picking through my own old files, I compiled the most complete archive of the Trans Girl Diaries gag comics so far. Check it out, this stuff is amazing.

Where do these things come from?

Turns out I used wget’s mirror function on the website once. The most bulletproof setting for this command is

wget -mkE http://example.com

This stuff is so great. It makes a copy of an entire website, including all pages, images, CSS and Javascript. Use it to grab a blog for reading on the plane, to make a static WordPress site if you are worried about security exploits but dislike updating, or to save your favourite webcomic for posterity.

Trigger warnings

Suicide, gender dysphoria, violence, external transphobia, internalized transphobia, Bailey-Blanchard-Lawrence two-type transwomen classification, transphobia, really intense descriptions of gender dysphoria, TERFism, sexism, homophobia, womyn-born-womyn-ism, Harry Benjamin syndrome and an altogether too realistic view of transgenderism.

If you like r/tgcj you’ll probably like the Trans Girl Diaries.

Review

I love this stuff. The comics meant a lot to me when I was younger. They are relatable and funny and give insight into all the disturbing thoughts that are part of the Trans Woman Experience. Whether you are trans or not, it is worth checking out.

Bayes’ theorem and transgender lesbians

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Some time ago I read a cool post on Tumblr, but I can’t find it anymore. It was about calculating P(trans|WLW), the fraction of women who love women that is transgender, from P(trans), the fraction of the general population that is transgender, P(WLW), the fraction of the population that is a woman-loving woman, and P(WLW|trans), the fraction of gynephillic trans women among trans people. Bayes’ theorem says

P(trans|WLW) = P(WLW|trans)P(trans)/P(WLW).

I remember that the resulting number was significant. As I could not find it again, here is a quick and dirty reconstruction. For every statistic, I picked the first one I found that did not seem completely unrealistic.

So Bayes’ theorem gives us P(trans|WLW) = 0.15.

Bonus: suicide attempts

While preparing this post, I stumbled upon this report. Page 8 lists:

  • P(attempted suicide) = 0.016.
  • P(attempted suicice|trans) = 0.41.

Bayes now says P(trans|attempted suicide) = 0.26. Big if true.*

Section of Doubt

Applying Bayes’ theorem like this seems to give unreasonably good mileage. That suggests that social scientists aren’t allowed to use numbers from different studies and get conclusions from them, or asymmetric misreporting makes these calculations error-prone.

The last number above is big. Makes one wonder why so little effort is spent explicitly targetting at-risk trans people.

* Added July 16th: I just met a subject expert, she said this figure sounded about right.