Transgender protections: Keeping kids safe

a gender neutral restroom for transgender people

The next time you need to use a public restroom, stand outside the door and take a moment to think about which one you should use. Would you feel safer in the ladies’ room, or would using the men’s room make you more comfortable? Now consider that the average person urinates between six and eight times a day — more often if they’re drinking a lot of fluids. Imagine facing this dilemma every time you feel the urge.

For cisgender people — those whose gender identity corresponds with their birth sex — it’s simply an inconsequential exercise. But for transgender children, teens and adults, the quandary of choosing between safety for themselves and potential discomfort for others is very real. “The everyday choices that cis folks take for granted can be exhausting and extremely stressful for trans people,” says Dr. Elizabeth Boskey, a clinical social worker in the Center for Gender Surgery at Boston Children’s Hospital.

Putting it to a vote

To address this concern, Massachusetts passed a law in 2016 that expanded anti-discrimination protections for the state’s transgender residents, allowing them to use restrooms, locker rooms and other public spaces that correspond with their gender identities. In the two years since its passage, there has been no increase in public safety incidents in restrooms in Massachusetts. In fact, a recent study found that the passage of such laws isn’t related to the number or frequency of criminal incidents in public spaces. It also concluded that reports of privacy and safety violations in restrooms, locker rooms and changing rooms are exceedingly rare.

Yet almost as soon as the law was signed, opponents began gathering signatures to require a statewide popular vote on it in 2018. This November 6, voters will be asked to decide whether to keep or repeal anti-discrimination protections for transgender people, including trans kids and teens. A “yes” vote on Question 3 will preserve the law, while a “no” vote will repeal these protections.

Sorting fact from fiction

Boston Children’s is one of thousands of institutions, community groups, businesses, law enforcement groups and other organizations and people who have joined the Freedom for All Massachusetts coalition to support a “yes” vote in November. “This is a message from the community that we need to be respectful of others,” explains Dr. Oren Ganor, co-director of the Center for Gender Surgery. “No one from any background should feel marginalized or abandoned.”

But misconceptions and misinformation still abound. Here’s what everyone should know about this issue.

It’s not just bathrooms. Although restrooms have become the best-known example of public accommodations in this debate, the current Massachusetts law protects trans people from discrimination in a range of facilities, including locker rooms, health clubs, fitting rooms and even health care settings — any public space where services or accommodations are segregated by sex.

This is a true concern. “Opponents of anti-discrimination protections claim that this will allow sexual predators access to opposite-sex restrooms,” says Dr. Kerry McGregor, a psychologist with Boston Children’s Gender Management Service. “However, trans people are actually more likely to be victims of harassment and violence themselves.”

In fact, surveys of transgender people have found that nearly a quarter of respondents report being challenged about their presence in a restroom in the past year, while one in eight say they were verbally harassed, physically attacked or sexually assaulted in a restroom in the past year.

No evidence of harm. Despite claims to the contrary, there’s no credible evidence that cis men are dressing as women to access public ladies’ rooms. “The truth is that trans women, in particular, are at increased risk for harm themselves,” says Boskey. “Why would anyone put themselves at risk for violence by pretending to be trans?”

The health consequences are serious. Discrimination can lead to anxiety, depression, suicidal ideation and other mental health problems — all of which have higher rates in trans kids and adults. Being denied access to or feeling unwelcome in public spaces can have physical implications, too. “Children and adults who avoid urinating in public tend to have an increased risk for problems such as urinary tract infections,” says David Diamond, MD, urologist-in-chief and co-director of the Center for Gender Surgery.

Indeed, research shows that more than half of trans people report avoiding using public restrooms; nearly a third have limited the amount they ate or drank to avoid using the restroom; and 8 percent reported having urinary problems as a result of that avoidance.

‘Everyone is somebody’s child’

Although anti-discrimination legislation can’t eliminate harassment, it can go a long way to helping both trans kids and adults feel safe just going about their day. “Massachusetts is a state that’s known for equality,” says McGregor. “Even the idea that we’re considering not protecting transgender people can cause a lot of anxiety for them.”

Parents and patients can help by educating their friends and families about the facts, adds Boskey. “With trans folks, all the scripts many people have for dealing with gender go out the window,” she explains. “But the truth is that your gender has no effect on someone else, and vice versa. The most important thing to remember is that everyone is somebody’s child.”

Learn about the Center for Gender Surgery and the Gender Management Service.