Identity
6 min

Media about trans issues is linked to an increase in referrals to gender identity clinics

A recent study finds a correlation, but whether the tone of these portrayals also affect referrals remains unanswered

Credit: Getty Images; Brian Wong/Xtra

A recent study has shown a link between news coverage of trans issues and an increase in youth referrals to gender identity clinics.

But those studying and working with trans youth and children—including the study’s authors—say that more attention needs to be drawn to the tremendously harmful effects of negative media coverage on trans youth, and to the lack of education on gender identity.

The Australian-British study was published in July in the peer-reviewed Journal of the American Medical Association. According to lead author Ken Pang, a doctor in the department of adolescent medicine at the Royal Children’s Hospital in Melbourne, the study is intended to examine the rise in referrals to gender identity clinics in recent years.

“Various theories and assumptions have been put forward,” he writes in an email. “We felt it was important to move beyond such theories and assumptions to look at the empirical evidence. The study is connected to my clinical work, which is with trans and gender-diverse children and adolescents.”

The study examined news items between 2009 and 2016 that mentioned trans issues and how they correlated with the number of referrals to gender identity clinics in Australia and the U.K. It found that within two weeks of the appearance of a media piece directly related to or entirely focused on trans issues, there was an increase in referrals to these clinics.

However, it does not break down the tone of news coverage or determine if negative coverage could lead to an increase in referrals, a weakness acknowledged in the study.

“Determining whether the sentiment and tone of media stories affect the association between media and clinical referral numbers would be important,” write the authors. “For example, in the past few years, there has been a significant amount of negative press coverage of the Gender Identity Development Service in the U.K., and it is possible that this may have dissuaded some young people and their families from seeking care. Testing whether negative media coverage is associated with reduced referral rates (and, conversely, whether positive coverage is associated with increased referrals rates) would thus be a useful next step.”

Pang says he’s seen the effects of negative coverage firsthand. “In my own practice, I’ve seen the effects of both positive and negative media coverage, and found that the latter can certainly be harmful to patients.”.

The authors also note that wider media acceptance of trans people may play a part in increased referrals. “It is likely that TGD [transgender and gender diverse]-related media has improved the recognition and acceptance of gender diversity in wider society, and this may have helped to create an environment that fosters referrals,” the study states. “For example, the increasing media portrayal of TGD individuals not only in real life (e.g. Caitlyn Jenner and Chelsea Manning) but also in popular fiction (e.g. in television shows, such as Transparent and Orange Is the New Black) is likely to have helped not only create an incremental shift in public awareness but also normalize gender diversity.”

But the study also recognizes that its findings might be used by right-wing and trans-exclusionary groups to try to discredit treatments for trans people.

“We are also mindful that others have speculated that increased media content (specifically via social media) might act as a double-edged sword or a means of social contagion, whereby some individuals erroneously come to believe through exposure to such media that their nonspecific emotional or bodily distress is due to gender dysphoria and being TGD,” write the authors. “Here, the implied outcome is that such individuals will then access gender-related medical interventions and eventually come to regret these once they realize that they are in fact not TGD.”

The researchers tried to preempt such charges by referring to a Dutch study that found only 0.5 percent of 4,000 patients who underwent treatment at a clinic between 1972 and 2015 later expressed regret.

In his interview with Xtra, Pang refers to an article from the Daily Mail, a right-wing U.K. tabloid, that takes the study’s findings out of context, attributing quotes from the study solely to Polly Carmichael, a British doctor who was only one of the authors. “The increasing portrayal of transgender characters on TV is fuelling a dramatic rise in the number of young people seeking medical help to change sex, a leading expert has said,” states the tabloid article.

“Polly Carmichael, who is head of Britain’s leading trans clinic for children, said that programmes such as Orange Is the New Black, Transparent and Butterfly helped ‘normalize gender diversity.’”

The Daily Mail also cherry-picked quotes to argue that treatment could be dangerous. “And she claimed exposure to social media could be persuading some children to ‘erroneously’ believe they are transgender,” reads the article, misstating the study’s findings.

Such coverage in the British press is not unusual, according to a 2019 study of the media portrayal of trans people by Paul Baker, a professor at the University of Lancaster.

“The U.K. press wrote over 6,000 articles about trans people in 2018-19,” writes Baker in his study. “On the surface there appear to have been improvements—the more sexualizing and joking uses of language around trans people have reduced since 2012 and there are many more stories around transphobia and inclusivity.”

But Baker argues that the increased coverage is being used to criticize trans people and to portray them as being unreasonable and aggressive.

“The picture suggests that the conservative press and most of the tabloids have shifted from an openly hostile and ridiculing stance on trans people towards a carefully worded but still very negative stance,” he writes.

The Daily Mail article is using the Pang study to continue that trend, says Jane Fae, a member of the British advocacy group Trans Media Watch.

“They did not need the media survey to do that. They already claim that transness is a fashion, or something created by ‘social contagion,’” she writes in an email. “In this, they exactly parallel what happened 30 years ago as anti-gay campaigners claimed they ‘had nothing against gay people, but….’ It is never clear what this meant beyond the idea that people might be so taken by the supposed media glitz surrounding gayness that they would instantly change their sexuality to fit in.”

The Pang study and the Daily Mail article illustrate the benefits and dangers that media coverage can provide for trans people, says Mia Fischer, an assistant professor in the department of communication at the University of Colorado, Denver. Fischer’s 2019 book, Terrorizing Gender: Transgender Visibility and the Surveillance Practices of the U.S. Security State, examines media coverage of transgender issues and the resulting backlash.

Fischer says the link the study found between media coverage and increased referrals seems logical. “It’s not a direct cause and effect,” Fischer says, “but you can’t be what you can’t see.

“We’ve definitely seen an increase in media visibility in trans issues since 2014, and an increase in trans representation,” she adds. “There are role models such as Laverne Cox or Caitlyn Jenner. There’s visibility in the national discourse.”

But increased visibility can mean more attacks, she says, citing the recent anti-trans writings of J.K. Rowling as an example. Rowling has written that trans women are not actually women and that some trans women are men using trans identities as a cover to prey on women.

“It explicitly causes backlash,” Fischer says. “It can lead to targeted, vicious attacks—it brings [the trans community] to the attention of those who want to do them harm. Rowling and the TERF [trans-exclusionary radical feminist] platform has gotten quite a bit of publicity.”

Fischer says increased coverage can be harmful and misleading if it includes misgendering or deadnaming, or if it falls back on stereotypes that portray trans people as “psychos or sex workers.”

Those portrayals can literally be life-threatening to vulnerable trans youth, says Alex Abramovich, a scientist with the Institute for Mental Health Policy Research at Toronto’s Centre for Addiction and Mental Health (CAMH). Abramovich has spent the past 15 years studying homelessness among LGBTQ2S+ youth.

In Toronto, Abramovich says, as many as 40 percent of homeless youth identify as LGBTQ2S+—many of them are trans, and many are on the streets because they’ve been disowned by their families. He says attacks such as those by Rowling can have a devastating effect.

“A lot of them are really suffering with their mental health, just trying to get by,” he says. “There’s suicidality and self-harm among a majority of the youth I work with. And then they’re going out in the world and seeing all this negative coverage, telling them there’s something wrong with you, you’re sick.”

But Abramovich does believe that positive media portrayals of trans lives are important to youth. “The portrayal of trans people in media, the portrayals in TV shows, helps to normalize your identity,” he says. “Media, pop culture and movies are a really large part of their lives. They’re very active on social media.”

But this reliance on the media points to a major problem in our educational system, says Abramovich. “A lot of things have changed over the past 10, 15 years, but the school system is still binary. Little kids pick up on these things at a very, very young age. In nursery school, it’s all heteronormative, the stories that are read to children are all cisgendered. In kindergarten, gym class is divided into boys and girls. It’s teaching children that those are the only gender identities there are.

“There are very, very easy ways to talk to young children about these things,” Abramovich adds. “But we keep saying, ‘We can’t possibly do this, they’re too young.’”

Even Pang, the lead author of the study on media coverage, says his work shows how crucial it is for schools to address these issues in a reliable and non-judgmental fashion—both for those who might be questioning their gender identity, and to help other young people be more understanding.

“While the media obviously plays a critical role in the provision of such information, other institutions—schools, universities, health services—have a critical role to play, too.”