May 18, 2021
Dear Friends and Family,
Without little doubt, this segment on Transgender Identity will be the most controversial of any segment in this series. It is a subject most people little knowledge about – from both a scientific and a personal interaction perspective. Further, the subject challenges deeply held paradigms of our society, discrimination is commonplace and often unchecked, and the social justice advocates are trying to “ram it down our throats.” My question is: “are the social justice advocates further victimizing this small group of people (0.7% of the population) in their quest to tear down our society and remake it?”
My Takeaways:
A key question in my developing a perspective on the transgender question: Is being trans a nonconsequential choice? The literature suggests that is not. Specifically, it asserts that trans people suffer from gender dysphoria – significant distress living with the sex they were born with. As we will find in the next segment some feel that way, but it passes. Others can’t get over it and they start a process of change -- transition if you will. This process must be terrifying. It begins with hormone treatment – a lengthy process of changing a person’s secondary sex characteristics (such a breast size and shape and facial hair), changing a person’s looks, and changing a person’s dress. That leads to significant discrimination, rejection, huge complications with dating as the excerpts report. Suicide is contemplated (reportedly by 80%) and is attempted by 41%. After that lengthy process then the person is faced with gender confirmation surgery which many do not opt to do for a variety of reasons (financially unaffordable, medical risk, etc.). All of this leads to the following conclusion in the excerpts, “Most transgender people agonize and delay transition for years precisely because of how hard it will be. When they do transition, it is because of all options available, transitioning is the least devastating. In short, transition is a choice only inasmuch as choosing between leading a full life and a sharply limited and unpleasant one is a choice.”
The next question for me is, “Is there a definitive medical explanation for being transgender?” The answer: No, not yet anyway. Dr. Debra Soh in Segment 12 suggested that sexual preference may very well be influenced by the amount of testosterone the fetus receives in the womb. Boys with lower-than- normal levels of testosterone, are more likely to be female-typical and girls with higher-than-normal levels are more likely to be male-typical. Hence a medical explanation for homosexuality which has appeared fairly recently in the medical community. Further she states MRI studies have shown differences between men and women in the amygdala (one of the four basal ganglia in each cerebral hemisphere that consists of almond-shaped mass of gray matter in the brain) which regulates sexual behavior. As stated in this segment’s excerpts by Dr. Soh, the neuroscience of being transgender to date have been inconclusive. Yet, in segment 12 she made a very interesting statement, “For more than 99% of us, our gender is our biological sex. Regarding the 1% of individuals for whom gender identity and biological sex don’t align, they may identify as transgender.”
So, the perspective I have developed on the transgender question is that the excerpt quote in the last three sentences in the first paragraph of “My Takeaways” is valid and probably quite accurate. As to medical science providing us with a scientific explanation for why transgender people are as they are, I have to wait for more scientific research, but I am not precluding there will be no such evidence.
You have to develop your own perspective. However, my guess is that there is semi-common agreement that the social justice warriors are over politicizing the transgender issue to promote their agenda. This may be detrimental to many people identifying as transgender, as will be discussed in the next segment.
Next:
In next week’s segment, “Transgender Identity: Children,” you will learn about some of the consequences of wokeness gone amuck with respect to childhood gender dysphoria.
Happy Learning,
Harley
Dear Friends and Family,
Without little doubt, this segment on Transgender Identity will be the most controversial of any segment in this series. It is a subject most people little knowledge about – from both a scientific and a personal interaction perspective. Further, the subject challenges deeply held paradigms of our society, discrimination is commonplace and often unchecked, and the social justice advocates are trying to “ram it down our throats.” My question is: “are the social justice advocates further victimizing this small group of people (0.7% of the population) in their quest to tear down our society and remake it?”
My Takeaways:
A key question in my developing a perspective on the transgender question: Is being trans a nonconsequential choice? The literature suggests that is not. Specifically, it asserts that trans people suffer from gender dysphoria – significant distress living with the sex they were born with. As we will find in the next segment some feel that way, but it passes. Others can’t get over it and they start a process of change -- transition if you will. This process must be terrifying. It begins with hormone treatment – a lengthy process of changing a person’s secondary sex characteristics (such a breast size and shape and facial hair), changing a person’s looks, and changing a person’s dress. That leads to significant discrimination, rejection, huge complications with dating as the excerpts report. Suicide is contemplated (reportedly by 80%) and is attempted by 41%. After that lengthy process then the person is faced with gender confirmation surgery which many do not opt to do for a variety of reasons (financially unaffordable, medical risk, etc.). All of this leads to the following conclusion in the excerpts, “Most transgender people agonize and delay transition for years precisely because of how hard it will be. When they do transition, it is because of all options available, transitioning is the least devastating. In short, transition is a choice only inasmuch as choosing between leading a full life and a sharply limited and unpleasant one is a choice.”
The next question for me is, “Is there a definitive medical explanation for being transgender?” The answer: No, not yet anyway. Dr. Debra Soh in Segment 12 suggested that sexual preference may very well be influenced by the amount of testosterone the fetus receives in the womb. Boys with lower-than- normal levels of testosterone, are more likely to be female-typical and girls with higher-than-normal levels are more likely to be male-typical. Hence a medical explanation for homosexuality which has appeared fairly recently in the medical community. Further she states MRI studies have shown differences between men and women in the amygdala (one of the four basal ganglia in each cerebral hemisphere that consists of almond-shaped mass of gray matter in the brain) which regulates sexual behavior. As stated in this segment’s excerpts by Dr. Soh, the neuroscience of being transgender to date have been inconclusive. Yet, in segment 12 she made a very interesting statement, “For more than 99% of us, our gender is our biological sex. Regarding the 1% of individuals for whom gender identity and biological sex don’t align, they may identify as transgender.”
So, the perspective I have developed on the transgender question is that the excerpt quote in the last three sentences in the first paragraph of “My Takeaways” is valid and probably quite accurate. As to medical science providing us with a scientific explanation for why transgender people are as they are, I have to wait for more scientific research, but I am not precluding there will be no such evidence.
You have to develop your own perspective. However, my guess is that there is semi-common agreement that the social justice warriors are over politicizing the transgender issue to promote their agenda. This may be detrimental to many people identifying as transgender, as will be discussed in the next segment.
Next:
In next week’s segment, “Transgender Identity: Children,” you will learn about some of the consequences of wokeness gone amuck with respect to childhood gender dysphoria.
Happy Learning,
Harley
NIHILISM: GOOD OR BAD? – SEGMENT 14
TRANSGENDER IDENTITY: ADULTS – EXCERPTS
TRANS 101: What is the difference between sex and gender? In very simplistic terms, sex is what’s between your legs and gender is what’s between your ears. Sex refers to physical characteristics and gender relates to behavioral and psychological ones. Gender is how we see ourselves, whether man, woman, neither or somewhere in between. Transgender people are those whose sex and gender do not match.
Is gender purely a social construct, or is it biological? It is a bit of both. Research shows that people have a biologically determined gender identity, and that even very young children can have gendered preferences in toys. Researchers are still exploring the interaction between the two, though it can be said that culture has a great deal to do with how we express our gender.
Are sexual orientation and gender identity the same thing? They are not the same thing. Transgender women (men who transition to women) are about equally likely to be attracted to men, women, or both. Transgender men are more likely to be oriented towards women.
What does it mean to be transgender? The term transgender describes individuals whose inherent sense of their own gender doesn’t match the sex they were assigned at birth. Many transgender individuals have experienced some of gender dysphoria, which is an intense and persistent sense of distress or discomfort with their birth sex.
What is gender dysphoria? Gender dysphoria is the diagnostic term used to describe “a marked difference between the individual’s expressed/experienced gender and the gender others would assign him or her, and it must continue for at least six months.”
Are transgender people pretending to be someone they know they’re not? No. Transgender people are who they say they are. They are fully aware of their biology, but due to gender dysphoria do not relate to their sex assigned at birth.
Does this mean that people who identify as transgender should be considered mentally ill? No. Gender nonconformity is not in itself a mental disorder. The critical element of gender dysphoria is the presence of clinically significant distress associated with the condition.
What causes an individual to be transgender? The precise causes are unknown, though some of the mechanisms are partially understood. Sexual differentiation of the brain happens later in pregnancy than differentiation of sex organs and is controlled by testosterone. If testosterone levels are too high or too low, the surge is mistimed, or the fetus does not process the testosterone correctly. It has been shown to affect gender identification, role behavior, and sexual orientation.
What does “transgender man” mean? How about “transgender woman?” A transgender man is a person who was seen as a female when they were born but identifies and lives as a man. A transgender woman is someone who was seen as a male when they were born but identifies and lives as a woman. In short, a transgender man is a man, and a transgender woman is a woman in the here and now (i.e. what they have transitioned to).
What is gender transition? This is the process of changing one’s gender presentation and expression from the one assigned at birth. Some people have changed or are in the process of changing their physical bodies to conform to their internal sense of gender identity. For others, this is purely a social process without medical intervention. Gender transition may proceed in the following order. First, the transgender person will meet with a mental health care provider to ascertain what steps are appropriate in addressing the incongruity between the person’s gender identity and sex that the person was assigned at birth. This could include social transition without any medical intervention. After appropriate counseling, the person may begin hormone therapy, under the supervision of mental and health care professionals. This step will begin the process of changing the person’s secondary sex characteristics (such as breast size and shape or facial hair) to those associated with the gender with which the person identifies. After a period of time on hormone therapy, many transgender people transition to “real-life experience” by living full-time in the gender role consistent with their gender identity (i.e. without any genital surgery). Last, some transgender people may undergo surgical procedures to change their appearance and/or body to conform with the identified gender.
Do all transgender people who transition follow the same process or even transition medically? Not all transitioning people go through the same process. Some may not undergo medical treatment for various personal, financial, or medical reasons, but may modify their gender expression – their dress, mannerisms, and so forth – to be consistent with their gender identity. Regardless of these factors, all transgender people are entitled to undertake the transition steps that are appropriate for them and must be treated with dignity and respect as they do so. Others may have hormone replacement therapy, breast augmentation or reduction (top surgery), hair removal, facial surgery, or gender confirmation surgery.
How many transgender people are there in the US? There are approximately 1.4 million transgender people in the US. This translates to about 0.7% of the population.
Are there laws protecting transgender people? There are no overarching federal laws explicitly protecting transgender people from discrimination in employment or most other areas of life. Twenty-two states and 225 jurisdictions include protections for transgender people in housing, employment, and sometimes public accommodations. As a result, transgender people in most parts of the country have very limited legal protections against discrimination.
Is dating for transgender people like LGB dating? No. Dating for transgender people is a unique experience. For starters, there is the question of what to tell about your history, and when. This can be extremely dangerous, and frequently goes very poorly. Violence is often a result. Another issue is that transgender women frequently don’t fit inside traditional notions of beauty. Men who do find transgender women attractive are often acting on a fetish rather than interest in them as individuals. Transgender women who are attracted to women often have an even more difficult time finding romantic partners than those attracted to men.
BEING TRANSGENDER ISN’T A CHOICE: Most transgender people agonize and delay transition for years precisely because of how hard it will be. When they do transition, it is because, of all options available, transitioning is the least devastating. In short, for many transgender people, transition is a choice only inasmuch as choosing between leading a full life and a sharply limited and unpleasant one is a “choice.”
Trans 201: Okay, you get that gender identity is different than gender expression, which is different than sexual orientation. You know that not everyone wants “the surgery.” You’re good with the idea transgender didn’t choose to be transgender. However, there’s a lot more to life as a transgender than just the basics. There are challenges in finding and keeping a job, and most states have no state-level protections for transgender people to prevent employment discrimination. It can be very difficult to get government ID, especially in states that have hefty surgical or legal requirements. There are a lot of myths and misconceptions about transgender people that make life more difficult. There’s outright danger of violence, and how transgender people are treated by the police and the legal system.
LBGT Americans, like most of the country, live in of two distinct political environments, with very little in between. LBGT people are either full citizens or are left completely to the whims of the multitudes who would do them harm. This trend is even more pronounced for transgender people. Attitudes towards transgender people in the US are more divided than jut about anywhere else in the world. The US leads the world in the percentages of people who believe being transgender is a sin and that society has gone too far in accepting them. At the same time, 73% of the public in the US believe that transgender people should be protected from discrimination by the government.
Source: Everything You Ever Wanted to Know about Trans by Brynn Tennehill.
THE NEUROSCIENCE OF BEING TRANSGENDER: I’m often asked whether the brain of someone who is transgender is different than the brain of someone who isn’t. The answer is yes and no. Research suggests, in addition to potential differences in the brain, there are other factors at play influencing a person’s feelings of gender dysphoria and their decision to transition, including the kind of sexual partners one seeks to attract. Thankfully, advances in brain-imaging technology have offered new insights into understanding dysphoria. One study from 2018 gained widespread headlines for suggesting that the brains of gender-dysphoric children are more similar to the sex they identify as, as opposed to their sex at birth, potentially offering support for the early transitioning approach.
In another study, from 2015, researchers measure cortical surface area, comparing three groups of children ages twelve to seventeen years old. The researchers found that the brains of the gender-dysphoric girls were shifted in a male-typical direction; they were more male-typical than girls without gender dysphoria, but less male-typical than boys. Both of these studies’ results, however, were confounded with sexual orientation, as all of the transgender participants were gay, while all of the controls were straight. It remains unclear whether the brain differences found were a reflection of gender identity (being transgender) or sexual orientation (being gay). It’s important to clarify, this is not to say that all transgender people are really just confused gay people. Research has shown that transitioning can indeed be beneficial for some people helping them to live much happier and healthier lives.
Source: The End of Gender by Dr. Debra Soh
TRANS: The debate around gay rights moved too swiftly for some people, but it still took decades to go from acceptance that homosexuality existed and might need to be accommodated to the position where gay marriage was legalized. By contrast trans has become something close to a dogma in record time. Conservative ministers in the British government are campaigning to make it easier for people to change their birth certificates and alter their sex at birth. A local authority has issued educational guidelines suggesting that in order to make transgender children feel more accepted, teachers in primary schools should tell children than “all genders,’ including boys, can have periods. And in the U.S. a federal bill was passed on May 2019 which redefines sex to include “gender identity.” Everywhere the feeling is the same. Among the crowd madnesses we are going through at the moment, trans has become like a battering ram.
In the 1960s and 1970s the few surgeons willing to carry out gender reconstruction surgery needed a number of assurances. One was that the patient must in no way be psychotic. Secondly, by changing sex the patient must not be abandoning anybody who depended on them in the sex they were currently in. Thirdly, the patient should have been undergoing hormone treatment for a length of time. And finally, the patient must have lived in the role of the gender they were adopting for a number of years. These basic principles have not changed much in the decades since.
Software to Hardware: No physiological differences have been shown to exist between trans and non-trans people. And though there has been some study of differences in the brain function, nothing to date has shown that there is a clear hardware reason why some people want to change from the body of one sex into that of another. Yet there is still a push – as with homosexuality – to move the issue from software to hardware. There is a drive to prove that trans people are “born this way.” If there is nothing genetically different about gay people, then the only thing that signifies a difference is their behavior. Gay people are gay when they say they are and when they do the things that show them to be gay. Likewise, perhaps, people who are trans when they say they are, and no outward sign of any biological signifier – need be there in the trans case any more than it is expected in the case of being gay.
But there is one very significant difference. A gay person who goes straight or a straight person who goes gay is doing nothing that is permanent of irreversible. Whereas the endpoint of trans advocates is irreversible and life-altering. Nobody like recalling the time when gay people were told “it just a phase,” but what if trans is (even on occasion) just a phase? And what if that phase is realized too late?
Source: The Madness of Crowds by Douglas Murray
The unabbreviated version of the above can be found in the pdf document below.
TRANSGENDER IDENTITY: ADULTS – EXCERPTS
TRANS 101: What is the difference between sex and gender? In very simplistic terms, sex is what’s between your legs and gender is what’s between your ears. Sex refers to physical characteristics and gender relates to behavioral and psychological ones. Gender is how we see ourselves, whether man, woman, neither or somewhere in between. Transgender people are those whose sex and gender do not match.
Is gender purely a social construct, or is it biological? It is a bit of both. Research shows that people have a biologically determined gender identity, and that even very young children can have gendered preferences in toys. Researchers are still exploring the interaction between the two, though it can be said that culture has a great deal to do with how we express our gender.
Are sexual orientation and gender identity the same thing? They are not the same thing. Transgender women (men who transition to women) are about equally likely to be attracted to men, women, or both. Transgender men are more likely to be oriented towards women.
What does it mean to be transgender? The term transgender describes individuals whose inherent sense of their own gender doesn’t match the sex they were assigned at birth. Many transgender individuals have experienced some of gender dysphoria, which is an intense and persistent sense of distress or discomfort with their birth sex.
What is gender dysphoria? Gender dysphoria is the diagnostic term used to describe “a marked difference between the individual’s expressed/experienced gender and the gender others would assign him or her, and it must continue for at least six months.”
Are transgender people pretending to be someone they know they’re not? No. Transgender people are who they say they are. They are fully aware of their biology, but due to gender dysphoria do not relate to their sex assigned at birth.
Does this mean that people who identify as transgender should be considered mentally ill? No. Gender nonconformity is not in itself a mental disorder. The critical element of gender dysphoria is the presence of clinically significant distress associated with the condition.
What causes an individual to be transgender? The precise causes are unknown, though some of the mechanisms are partially understood. Sexual differentiation of the brain happens later in pregnancy than differentiation of sex organs and is controlled by testosterone. If testosterone levels are too high or too low, the surge is mistimed, or the fetus does not process the testosterone correctly. It has been shown to affect gender identification, role behavior, and sexual orientation.
What does “transgender man” mean? How about “transgender woman?” A transgender man is a person who was seen as a female when they were born but identifies and lives as a man. A transgender woman is someone who was seen as a male when they were born but identifies and lives as a woman. In short, a transgender man is a man, and a transgender woman is a woman in the here and now (i.e. what they have transitioned to).
What is gender transition? This is the process of changing one’s gender presentation and expression from the one assigned at birth. Some people have changed or are in the process of changing their physical bodies to conform to their internal sense of gender identity. For others, this is purely a social process without medical intervention. Gender transition may proceed in the following order. First, the transgender person will meet with a mental health care provider to ascertain what steps are appropriate in addressing the incongruity between the person’s gender identity and sex that the person was assigned at birth. This could include social transition without any medical intervention. After appropriate counseling, the person may begin hormone therapy, under the supervision of mental and health care professionals. This step will begin the process of changing the person’s secondary sex characteristics (such as breast size and shape or facial hair) to those associated with the gender with which the person identifies. After a period of time on hormone therapy, many transgender people transition to “real-life experience” by living full-time in the gender role consistent with their gender identity (i.e. without any genital surgery). Last, some transgender people may undergo surgical procedures to change their appearance and/or body to conform with the identified gender.
Do all transgender people who transition follow the same process or even transition medically? Not all transitioning people go through the same process. Some may not undergo medical treatment for various personal, financial, or medical reasons, but may modify their gender expression – their dress, mannerisms, and so forth – to be consistent with their gender identity. Regardless of these factors, all transgender people are entitled to undertake the transition steps that are appropriate for them and must be treated with dignity and respect as they do so. Others may have hormone replacement therapy, breast augmentation or reduction (top surgery), hair removal, facial surgery, or gender confirmation surgery.
How many transgender people are there in the US? There are approximately 1.4 million transgender people in the US. This translates to about 0.7% of the population.
Are there laws protecting transgender people? There are no overarching federal laws explicitly protecting transgender people from discrimination in employment or most other areas of life. Twenty-two states and 225 jurisdictions include protections for transgender people in housing, employment, and sometimes public accommodations. As a result, transgender people in most parts of the country have very limited legal protections against discrimination.
Is dating for transgender people like LGB dating? No. Dating for transgender people is a unique experience. For starters, there is the question of what to tell about your history, and when. This can be extremely dangerous, and frequently goes very poorly. Violence is often a result. Another issue is that transgender women frequently don’t fit inside traditional notions of beauty. Men who do find transgender women attractive are often acting on a fetish rather than interest in them as individuals. Transgender women who are attracted to women often have an even more difficult time finding romantic partners than those attracted to men.
BEING TRANSGENDER ISN’T A CHOICE: Most transgender people agonize and delay transition for years precisely because of how hard it will be. When they do transition, it is because, of all options available, transitioning is the least devastating. In short, for many transgender people, transition is a choice only inasmuch as choosing between leading a full life and a sharply limited and unpleasant one is a “choice.”
Trans 201: Okay, you get that gender identity is different than gender expression, which is different than sexual orientation. You know that not everyone wants “the surgery.” You’re good with the idea transgender didn’t choose to be transgender. However, there’s a lot more to life as a transgender than just the basics. There are challenges in finding and keeping a job, and most states have no state-level protections for transgender people to prevent employment discrimination. It can be very difficult to get government ID, especially in states that have hefty surgical or legal requirements. There are a lot of myths and misconceptions about transgender people that make life more difficult. There’s outright danger of violence, and how transgender people are treated by the police and the legal system.
LBGT Americans, like most of the country, live in of two distinct political environments, with very little in between. LBGT people are either full citizens or are left completely to the whims of the multitudes who would do them harm. This trend is even more pronounced for transgender people. Attitudes towards transgender people in the US are more divided than jut about anywhere else in the world. The US leads the world in the percentages of people who believe being transgender is a sin and that society has gone too far in accepting them. At the same time, 73% of the public in the US believe that transgender people should be protected from discrimination by the government.
Source: Everything You Ever Wanted to Know about Trans by Brynn Tennehill.
THE NEUROSCIENCE OF BEING TRANSGENDER: I’m often asked whether the brain of someone who is transgender is different than the brain of someone who isn’t. The answer is yes and no. Research suggests, in addition to potential differences in the brain, there are other factors at play influencing a person’s feelings of gender dysphoria and their decision to transition, including the kind of sexual partners one seeks to attract. Thankfully, advances in brain-imaging technology have offered new insights into understanding dysphoria. One study from 2018 gained widespread headlines for suggesting that the brains of gender-dysphoric children are more similar to the sex they identify as, as opposed to their sex at birth, potentially offering support for the early transitioning approach.
In another study, from 2015, researchers measure cortical surface area, comparing three groups of children ages twelve to seventeen years old. The researchers found that the brains of the gender-dysphoric girls were shifted in a male-typical direction; they were more male-typical than girls without gender dysphoria, but less male-typical than boys. Both of these studies’ results, however, were confounded with sexual orientation, as all of the transgender participants were gay, while all of the controls were straight. It remains unclear whether the brain differences found were a reflection of gender identity (being transgender) or sexual orientation (being gay). It’s important to clarify, this is not to say that all transgender people are really just confused gay people. Research has shown that transitioning can indeed be beneficial for some people helping them to live much happier and healthier lives.
Source: The End of Gender by Dr. Debra Soh
TRANS: The debate around gay rights moved too swiftly for some people, but it still took decades to go from acceptance that homosexuality existed and might need to be accommodated to the position where gay marriage was legalized. By contrast trans has become something close to a dogma in record time. Conservative ministers in the British government are campaigning to make it easier for people to change their birth certificates and alter their sex at birth. A local authority has issued educational guidelines suggesting that in order to make transgender children feel more accepted, teachers in primary schools should tell children than “all genders,’ including boys, can have periods. And in the U.S. a federal bill was passed on May 2019 which redefines sex to include “gender identity.” Everywhere the feeling is the same. Among the crowd madnesses we are going through at the moment, trans has become like a battering ram.
In the 1960s and 1970s the few surgeons willing to carry out gender reconstruction surgery needed a number of assurances. One was that the patient must in no way be psychotic. Secondly, by changing sex the patient must not be abandoning anybody who depended on them in the sex they were currently in. Thirdly, the patient should have been undergoing hormone treatment for a length of time. And finally, the patient must have lived in the role of the gender they were adopting for a number of years. These basic principles have not changed much in the decades since.
Software to Hardware: No physiological differences have been shown to exist between trans and non-trans people. And though there has been some study of differences in the brain function, nothing to date has shown that there is a clear hardware reason why some people want to change from the body of one sex into that of another. Yet there is still a push – as with homosexuality – to move the issue from software to hardware. There is a drive to prove that trans people are “born this way.” If there is nothing genetically different about gay people, then the only thing that signifies a difference is their behavior. Gay people are gay when they say they are and when they do the things that show them to be gay. Likewise, perhaps, people who are trans when they say they are, and no outward sign of any biological signifier – need be there in the trans case any more than it is expected in the case of being gay.
But there is one very significant difference. A gay person who goes straight or a straight person who goes gay is doing nothing that is permanent of irreversible. Whereas the endpoint of trans advocates is irreversible and life-altering. Nobody like recalling the time when gay people were told “it just a phase,” but what if trans is (even on occasion) just a phase? And what if that phase is realized too late?
Source: The Madness of Crowds by Douglas Murray
The unabbreviated version of the above can be found in the pdf document below.
| 14_nihilsim_long_transgender_adults_--_segment_14.pdf |