Just like any traumatic experience, I can remember exactly where I was when the phone rang. Immediately, I had the feeling that something terrible had happened. On the other end of the call was a mother, frantically looking for her child. Her transgender daughter had been missing for several days, which was unlike her. Her mother wanted to know if I had contact with her daughter, as I was, in my role as clinic director and healthcare provider, one of few people outside of the family who had semi-regular interactions with her. After several days of searching, her car was found near a bridge. She had ended her short life in an instant.
This Saturday, November 20, marks the annual observance of Transgender Day of Awareness, a day to honor the memories of transgender individuals who have been murdered in the past year. The event includes vigils, a reading of victims’ names, and marches to bring awareness to the violence and victimization experienced by transgender and gender expansive individuals.
There is great need for the day. The Human Rights Campaign has been monitoring the murders of transgender and gender expansive individuals since 2013. While the numbers are likely underreported due to the potential of unknown cause of death or misreporting of an individual’s gender identity, this tally of murders has offered some insights. For example, Black transgender women are the most targeted population and murdered at higher rates than any other subgroup. Unfortunately, while 2020 was the year with the highest number of murders of transgender individuals, 2021 has already surpassed 2020, with 46 transgender and gender expansive individuals being murdered, again the majority of whom are Black transgender women.
Transgender Day of Awareness is set at the end of Transgender Awareness Week. During Transgender Awareness Week, events are held that offer education on transgender or gender expansive/non-binary experiences and issues. Education on the increased prevalence of anxiety, depression, self-injurious behaviors and suicide attempts among transgender and gender expansive folks is important for shedding light on the struggles that transgender and nonbinary folks face. Understanding these increased rates of co-occurring issues with the frame of the Gender Minority Stress and Resilience Model helps us understand how experienced or observed violence, victimization, non-affirmation and rejection can negatively impact individuals’ mental health. Just as important to note are protective factors such as parental/caregiver support and affirming school policies and groups that are supportive of transgender and nonbinary youth, as well as school or medical forms to capture gender identity separate from assigned sex at birth and to use a person’s chosen name and pronouns.
Whenever November comes around, I naturally think of the patient we lost to suicide. As an ally and a provider, I wonder what more we could have done to support this youth. How could we have better educated her family, friends, and school about how to care for transgender individuals? How could we have provided more supports for her in her transition? How could we help to change the society she lived in, to make this a place where she could find a life worth living?
Looking at the data from our Yale Pediatric Gender Program, where we have served over 300 youth, I know this is likely not the last time we will experience a suicide of one of our patients. 54% of our youth report suicidal ideation and 27% have previously attempted suicide, underscoring the increased risk for suicide transgender and nonbinary youths, compared to cis youth. We may also experience a patient murder, as 32% of our patients identify as transgender women and 6% identify as Black.
It is time to recognize the impact of bullying and victimization on transgender and nonbinary individuals. To take a stand to say that transgender healthcare is a human right. To interject to stop harassment and bullying when it occurs. To protect transgender and nonbinary people, especially Black transgender women and girls. And to offer more inclusive community supports to be able to foster a sense of pride and connectedness to transgender and nonbinary individuals.
While the odds sadly suggest I will have another patient suicide at some point, I am very hopeful that our society can be more inclusive and show light and hope to our transgender and nonbinary fellow citizens. It is my hope that on this year’s Transgender Day of Awareness, as the names of every transgender and nonbinary person who has been murdered in the past year are read aloud, that folks take a second to reflect on how they can use their cis privilege to decrease harassment and violence toward transgender and nonbinary individuals. It is the least we can do.