Her father told the funeral director to use her birth name. Her husband said she had changed it years ago, and that using it would disrespect who she was. The funeral director was left between them, unsure whom to follow.

The woman was a client of Sean M. Downing, a probate attorney in Dedham, Massachusetts, who described the dispute without identifying her. For transgender people, the fight over identity can continue after death, when the person most affected can no longer speak for themselves. Who controls the funeral? Which name and gender go on the death certificate? Who has authority over the estate when relatives disagree about the person who died? The answers depend on state law, and they can change completely from one state to the next.

Massachusetts: When your legal name becomes someone else’s paperwork

In Massachusetts, the death record starts with the family. A relative or other informant fills out an informant worksheet with the deceased person’s legal and personal information, and the record itself lists the “name of deceased, including surname at birth or adoption” (Mass. Gen. Laws ch. 46, § 1). Once it’s filed, corrections “can be made only to reflect the correct information at the time of the event” (ch. 46, § 13). Neither section says how a person’s gender identity should be recorded at death.

For a transgender person who legally changed their name, an incorrect record can cause problems in estate administration, insurance claims, financial transactions and other official processes. A wrong name can create another obstacle at the exact moment surviving loved ones are grieving.

Downing, an associate at Samuel, Sayward & Baler who works with transgender and other LGBTQ+ clients, said that “during a probate, the personal representative or executor must use the deceased person’s legal name on record for the probate (i.e., what name appears on the deceased person’s government IDs).” But “attorneys can try to clarify a deceased trans person’s identity by using ‘a/k/a’ on the probate petition. The deceased person’s legal name would still be listed first, but the deceased person’s preferred name would also be listed.”

To protect a person’s legacy and make things easier for the family, Downing recommends a formal legal name change first. When that isn’t possible or wanted, he suggests that “the trans client may want to (1) use ‘a/k/a’ throughout all of their documents to include both their legal and preferred names, (2) name fiduciaries and other agents in their documents who will respect their gender identity, (3) include provisions in their health care proxy imploring their health care agent to consider their gender affirming care to be a necessary part of their health care, and (4) including provisions in their Will or other Directive directing the details of their funeral/memorial service or burial (particularly with respect to clothing/makeup worn and pronouns used).”

Massachusetts has a formal process for changing a name during life. Adults file name-change forms with the Probate and Family Court, which may approve a petition without the person appearing in court, though in some cases it orders notice to interested parties. The harder question after death is whether the people handling the paperwork will have the documents, and the willingness, to preserve the identity the person established.

New York: A chosen person may still have to prove they belong in court

A transgender person can know exactly who they want handling their affairs after death. It might be a spouse, a best friend, or the person who helped them survive a family that never accepted them. They might even put that choice in a will. But a signature on a document does not turn a chosen person into an executor with immediate authority. In New York, the will must go through probate, and the Surrogate’s Court must appoint the person who will administer the estate. As the state court system explains, “When a person dies, who inherits depends on whether there is a Will and who the living relatives are and their relationship to the person who died.”

The original will is filed in the Surrogate’s Court of the county where the person was domiciled. Relatives who would inherit if there were no will, known as distributees, must be notified, and they can consent to the appointment or object. Who counts depends on the family: parents are notified only if the person left no spouse or children, and siblings only if there are also no surviving parents (EPTL § 4-1.1). Notice doesn’t make a relative the executor, but it gives them a voice in the proceeding. Meanwhile, the person named in the will has to wait for the court’s appointment before they can act as someone who will, in the court’s words, “give out the estate (everything of value) that belonged to the person who died and carry out the wishes of the person who died.”

Peter J. Strauss, senior counsel at Pierro, Connor & Strauss in New York City, said a transgender person’s name change can be reflected directly in the Surrogate’s Court proceeding. The person seeking appointment as executor or administrator would submit a petition “with a caption stating the new name and adding ‘formerly known as (X)’” and set out the essential facts of the name change. If the person had obtained a court order allowing the change, Strauss said, that order “should be attached to the petition.”

The death certificate is a separate problem. Outside New York City, the state health department says that if a person did not change the gender on their birth certificate before they died, “this change cannot be made after their death.” New York City dropped that requirement in a law that took effect this April, so whether a death certificate can be corrected can depend on which side of the city line someone died.

For anyone who wants a nonrelative to manage their affairs, the practical work should happen before an emergency. The will must be legally valid, easy to locate and clear about the intended executor. Separate instructions may be needed for decisions that come up before probate is finished, particularly about personal belongings that don’t fit neatly into legal property. In New York, the gap is between being the person someone chose and becoming the person the court authorizes.

California: When the family’s word isn’t final

California goes further than either state. Under the Respect After Death Act, whoever completes a death certificate “shall record the decedent’s sex to reflect the decedent’s gender identity as female, male, or nonbinary” (Cal. Health & Safety Code § 102875). The informant, usually a relative, reports that identity, but documents outrank the informant: a birth certificate, driver’s license, Social Security record, court order approving a name or gender change, passport, advance health care directive, or proof of clinical treatment for gender transition. If no such document is shown and people disagree, the person with legal control of the remains decides.

Kathleen A. Hunt, an estate planning and probate attorney at Unique Law in El Cerrito, said that “here in California, there is generally a lot of deference given to the gender preferences of the deceased.” In practice, she said, the funeral director asks the family or another informant for the person’s details, including whether they legally updated their state ID, and enters what they’re told. “As an attorney, I choose how to refer to the decedent in all legal paperwork, and I have not yet run into any problems with the death certificate—as long as the reporting individual provides the correct information in the first place.”

That first report carries weight. “If the reporting individual provides the gender assigned at birth, that is going to appear on the death certificate; even if later corrected, the only result would be a second page on the death certificate, rather than a clean new version,” Hunt said. Under state law, an amendment becomes part of the original record, and the state health department describes the result as a multi-page certificate.

The same care applies to court documents. “The legal name must be used on legal paperwork,” Hunt said, “but it is possible to include preferred names as ‘also known as’ additions.” She urged planning: “Members of the LGBTQ+ community should definitely pay attention to estate planning, particularly with respect to ‘chosen family’ who might otherwise be bulldozed (or ignored entirely) by ‘family of origin’.”

When a person dies, they leave behind far more than money: photographs, journals, letters, clothing, artwork, and objects that carry meaning no inventory can capture. They may have wanted a particular friend to have those things, and certain relatives not to. In California, an executor named in a will has no power to act until a court appoints them (Probate Code § 8400), and a trustee must keep beneficiaries “reasonably informed” (§ 16060). Beneficiaries who believe a trustee isn’t following the trust can petition the court.

Without a will, the risk is larger. California’s intestate succession rules (Probate Code §§ 6400–6414) pass property to surviving relatives in a set order. A chosen family member does not become an heir because they were the person’s closest relationship. Love does not create inheritance rights. Someone who wants a partner or friend to receive specific belongings should not rely on conversations alone; a will, trust, beneficiary designation or other arrangement may be needed, depending on what’s being passed on and how.

Who controls the funeral?

The scene Downing described turns on a question the law answers in two of these states. In California and New York, a person can name someone in advance to control the disposition of their remains, and without that designation a surviving spouse outranks a parent (Cal. Health & Safety Code § 7100; N.Y. Public Health Law § 4201). In California, that person also settles death-certificate disputes when no document does.

Massachusetts has no such statute. A bill that would have created one, S.1217, was sent to study last December. In a dispute like the one between that father and husband, no Massachusetts statute says who decides.

The documents are not interchangeable

These three states reveal a problem that is easy to miss while someone is alive: no single document controls every decision after death. Planning doesn’t guarantee that relatives will respect a person’s identity, but it can reduce the number of decisions left to guesswork. A person can tell trusted people where their documents are, name the person they want handling their estate, and put their wishes for the funeral in writing.

The need for this preparation isn’t unique to transgender people. Families fight over money, funerals and belongings in many circumstances. But when a family has rejected someone’s gender identity or refused to recognize their chosen relationships, the dispute carries an added risk: that others will rewrite the person’s life after they can no longer correct the record.

Julia Gendin is a neuroscience and pre-law student at Boston University who writes about law, identity and the institutions that translate people’s lives into official categories.

For nearly four years, I worked in communications for a national LGBTQI+ organization. Much of my job involved responding to reporters, sitting for interviews, writing and trying to make complicated policy and legal developments easier for people to understand. That also meant noticing the circumstances under which people seemed most interested in hearing from trans people. There was almost always something happening that needed to be explained: a new law, a court decision, a restriction on healthcare, a school policy or another government agency deciding which parts of our lives it suddenly had an interest in regulating.

I believed deeply in the importance of that work, and I still do. There are real consequences when the public doesn’t understand what a policy means for the people who have to live under it. News also requires something to have happened, and I don’t expect a reporter to show up at someone’s house because a trans person had a reasonably pleasant Tuesday. But after years of explaining trans lives through the things happening to us, I started wondering what gets lost when crisis becomes one of the primary ways people encounter us.

I know this personally because I am the named plaintiff in Orr v. Trump, a federal lawsuit over the Trump administration’s passport policy for trans Americans. Being a plaintiff has required me to talk publicly about parts of my life I otherwise would have little reason to explain to strangers, and I chose to do that because I believe it matters. Being able to move through the world with identification that accurately reflects who you are affects everything from traveling and applying for jobs to whether you can hand someone your ID without wondering what will happen next. At the same time, it is strange to have something so politically significant become one of the most publicly recognizable facts about me when it represents so little of what it actually feels like to live my life.

Most days, my life is remarkably ordinary. I ride my bike, play board games with my spouse and friends, snuggle with our cats, fall asleep reading books and travel whenever I can. I get too invested in whatever new hobby has caught my attention—looking at you, bead tapestries—and spend an embarrassing amount of time wondering whether my beard looks good, whether my clothes fit the way I want them to or whether my body looks the way I think it should. These things occupy far more space in my life than federal litigation, and most of them aren’t interesting to anyone outside of it. I think that’s exactly the point.

Trans people have spent years being asked to make the most difficult parts of our lives useful to other people. We explain our healthcare so someone else can understand why we need it, our childhoods so someone else can understand how long we have known ourselves and our experiences of discrimination so someone else can understand the consequences of anti-trans politics. We explain our families, bodies and relationships, and sometimes the worst things anyone has ever done to us, because there is always the possibility that the person listening might understand trans people differently afterward.

There is enormous value in that kind of storytelling. I have also started to wonder what happens when suffering becomes the most publicly useful thing about us. If someone primarily encounters trans people when we are explaining why something hurts, what has been taken from us or why we are afraid, they may understand the danger we face without understanding much about the lives we actually live.

Even the way we talk about trans joy can carry the same expectation. There is the person who survived everything and built an extraordinary life anyway, the kid who was finally allowed to transition and is now thriving or the trans person who became the first to accomplish something previously inaccessible. Those stories deserve to be told. But somewhere between tragedy and triumph is where most people actually live, and I don’t think we have become very good at making room for trans people who exist there.

Not every trans person has a compelling transition story. Not everyone remembers knowing exactly who they were at three years old, and plenty of people took years to understand themselves. Some people’s families reacted terribly when they came out, while others were mostly concerned with getting their name and pronouns right. Some people transitioned and became much happier but still hate their jobs, struggle with money, have complicated relationships, pick up hobbies they abandon three weeks later and spend too much time worrying about things that will never matter.

There are also trans people who are selfish, irritating, difficult or simply unkind. Let trans people be villains. Marginalized people are often easiest to defend when we are sympathetic, and there is something deeply unfair about requiring someone to be likeable before deciding they are worthy of dignity. The trans person whose story is supposed to change someone’s mind is asked to be vulnerable enough to create empathy but composed enough to remain credible, angry enough that the harm feels real but not so angry that someone stops listening. After years of preparing for interviews and thinking about how something would land with an audience, I became very familiar with those calculations.

Sometimes those calculations are necessary. They are also exhausting when you realize how much freedom there is in being allowed to disappoint people only as yourself. A cisgender person can be an asshole without anyone treating their behavior as meaningful evidence about cisgender people as a population. Trans people deserve the same freedom to be mediocre, annoying, wrong or unlikeable without someone deciding our individual failures reveal something larger about whether people like us deserve to exist comfortably in the world.

I want that freedom in happier and more boring ways, too. I want trans people to get old enough that the biggest events in their lives have nothing to do with transition. I want someone to have been on hormones for 30 years and realize they forgot the anniversary. I want trans adults whose lives have accumulated so many careers, relationships, mistakes, hobbies, moves, vacations and friendships that being trans remains part of who they are without needing to remain the organizing principle of their biography.

I especially want that kind of life for trans kids, who have been asked to become public advocates for themselves at ages when most children should be allowed to worry about smaller things. Young trans people have testified before legislatures, spoken at school board meetings and answered deeply personal questions from adults with the power to make decisions about their lives. I admire the young people who are able to do that, but I don’t want courage to be required of them. I want trans kids to be bad at algebra, care more about whether someone likes them back than what their state legislature is doing, make questionable fashion choices, get embarrassed by their parents and eventually look back at photographs of themselves from middle school with the same horror afforded to everyone else.

For years, my work involved thinking about which stories could make someone understand something they hadn’t understood before. I still believe that work is necessary, but I have become increasingly uncomfortable with the idea that trans people have to make our lives useful in order for other people to find them worth knowing.

There should be room in the public record for the parts of our lives that don’t prove anything. The hobbies someone picked up and abandoned, the place they grew up and still miss, the career they thought they wanted until they didn’t, the vacation they saved for, the person they loved, the friend they haven’t spoken to in years and the stretches of time when nothing important happened all tell us something about a person’s life without needing to tell us anything about trans people as a whole.

Right now, much of the public record of trans life is necessarily a record of conflict. People looking back at this period will find legislation, litigation, healthcare restrictions, discrimination, protest and resistance. They will know what governments tried to take from us and how hard trans people fought to keep it. Those things belong in the record. I just hope that isn’t all anyone finds.

I hope they also know what we did on Tuesday.

I hope they know that we went to work and came home, fell in love and got bored, changed our minds, made bad decisions, found new hobbies, abandoned old ones and worried about things that had absolutely nothing to do with gender. I hope they know some of us did extraordinary things and most of us didn’t, and that neither group was more deserving of a full life than the other.

Trans people deserve stories about our survival, our joy, our resistance and the extraordinary things people in our community accomplish, but we also deserve stories that ask nothing from us. Sometimes there is no larger lesson, no remarkable act of courage and nothing useful to take away from someone’s existence. Sometimes a person is simply living their life, and I want there to be enough room in the way we understand trans people for that life to matter, too.

Trans people deserve to be boring.

*Ash Lazarus Orr is a trans journalist, photographer and communications strategist from rural Appalachia, the creator of Conversations Across Borders, and the named plaintiff in Orr v. Trump.*

When I was born, everyone thought I was a girl. No questions, no doubts. I wonder if my parents ever knew that there could be any doubts. I was born in the industrial Ukrainian city of Donetsk, which is famous for its steel industry and had never been known for being especially progressive. Quite the opposite: it was much more conservative than other parts of Ukraine.

I knew I wasn’t a girl from the age of four, maybe earlier, if only I could remember it. It started almost like play. I asked everyone to call me Mowgli, like the character in my favorite version of The Jungle Book. I preferred the pronoun “he”. I wondered why I couldn’t have a beard when I grew up.

Adults treated it as harmless play, until they didn’t. Until it started to feel like it could be something sinful to them.

And my family were more religious Christians than most of the families I knew. Ukraine in the 1990s was nothing like what some people might imagine from watching TV news today. Today’s Ukraine is much more modern and European, while at the same time being religious. When I was a child, most adults I knew confused the stories of Noah and Moses from the Bible. Meanwhile, my father did not just read the Bible; he studied the Holy Fathers and listened to lectures for future priests. He wasn’t a priest—he was an engineer—but his devotion to religion grew with every year. He preached to my godmother, our neighbors, and our relatives.

Unfortunately, there is no affirmative theology in the Russian Orthodox Church—and my family was from the Russian Orthodox Church, not from the Ukrainian Orthodox Church, and very pro-Russian in general - which means, once again, more conservative. Transness and queerness were things my family would never mention in front of a child.

But all the same, I knew I wasn’t a girl. Out of simple self-preservation, I refused to be bullied in kindergarten for my non-feminine pronouns, and I tried to be good by calling myself a “girl”. When I think about little me, I feel such a profound desire to protect them that I dream about time travel.

I remember clinging to traditionally feminine interests, like dolls and parenting magazines, at the age of five, rather than the military history my grandpa told me about. At the same time, I struggled to understand why those interests should determine gender. I felt that gender and sex were not the same, but I didn’t have the words to describe it. I knew that I might like dolls or I might like bikes, but that didn’t make me a girl.

I wasn’t “just a tomboy.” I wasn’t even a tomboy. I was me: a little person who didn’t associate themself with girls and felt, physically, that something was wrong without having any explanation for it. A daydreaming geek. Who wasn’t a girl.

In my childhood and teenage years, I never met another trans person. I was restricted from using the internet, so I didn’t see any proper representation. My family wasn’t the kind of family that watched talk shows with trans people or other “dirty”, “anti-intellectual” programs, as they would call them.

I was raised hearing that gay people were going to hell. I learned conspiracy theories about the Global West—the idea that all Western powers, ruled by a secret group of almost-satanic oligarchs who don’t have real democracy or actual cultural differences inside “Western” countries. It’s something like an extremely popular post-Soviet analogy of QAnon theory before QAnons was even a thing. Part of this theory was the idea that this mystical “Global West” spread LGBT propaganda to make Slavic people infertile, or to promote pedophilia in the name of globalism. I know, it’s weird. Luckily, I didn’t believe in this conspiracy, but unfortunately, the “Global West” conspiracy fear stopped adults from letting me learn more about queerness, because my teachers and parents wouldn’t allow me to have queer-friendly books, and my time on the internet was restricted. At eighteen, I still didn’t even know the difference between a drag queen and a trans person. I was scared to learn because of religious trauma and societal pressure.

At my worst moments, I thought my physical discomfort and dysphoria during my teenage years were caused by sin and the fact that I couldn’t pray properly—a sign that I was going to hell. At my best moments, I saw it as internalized misogyny. And I couldn’t have been more wrong in both cases.

But, anyway, there was no way someone could have “promoted” “trans ideology” to me.

Because there is no ideology.

What the modern media calls “trans ideology” and “trans propaganda” is just the acknowledgement of a simple fact: some people are trans. We don’t know why, but we know that trans people have always existed, despite the fact that societies throughout human history have not been very trans-friendly. And we know that there are trans people in cultures and communities that do not support trans rights and do not provide trans representation. I am one of them.

I was lucky and privileged enough to be able to separate myself from my abusive family, to have free access to the internet as an adult, and to meet other trans people, first online. At 23–24, I finally accepted that I’m a transmasculine non-binary person, and it helped me better understand my body and my past. It made me happier. When I speak with conservatives, I just present myself as a male, and it feels much more natural to me than pretending to be a woman.

I had the childhood that far-right activists and trans-exclusionary “feminists” now want all trans children to have before social transition. No information about trans people. No support. As a result, I developed depression, very severe obsessive-compulsive disorder, and what was likely a dissociative condition.

I didn’t have puberty blockers when I was a teenager, just as conservatives and transphobes want, and it left me feeling detached from my body, from my senses, and from my own life, and had suicidal thoughts.

The JAMA Network Open (2022) study showed that appropriate gender-affirming care for young people was associated with 60% lower odds of moderate or severe depression and 73% lower odds of suicidality over a 12-month follow-up—and it was supported by other studies. Meanwhile, the Cass Review is now actively promoted in the UK (the country of my residence) and shapes British policy, despite serious criticism from academics of its methodology and consistency. Moreover, more than 200 Educational Psychologists signed an open letter expressing concerns about the Cass Review.

We also know that there are rare cases of people who regret transitioning, just as people regret many other decisions in their lives. The gender-affirming surgery regret is under 1%. But we don’t talk about prohibiting parenthood because some people regret having children, or prohibiting cosmetic surgery, despite the fact that there are far more regrets associated with cosmetic and other surgery (runs 5 to 33% depending on the procedure) and parenthood regret (5 to 14%). The idea that trans children and teenagers shouldn’t be allowed to be themselves, and that they become trans because of propaganda, has nothing to do with reality. It is a paternalistic, ageist idea based on the belief that until the age of 18, people don’t have the right to their own opinions or bodily autonomy. When I was a teen and spoke about family abuse, I noticed that people laughed at me, but when I repeated the same words as an adult, they took me seriously. Unfortunately, the same happened with any complaints I made, including those regarding my mental health.

People don’t understand that they aren’t just making kids less happy for their own comfort; they are actively causing harm for adults as well. Anti-LGBT laws almost always start with minors. For example, in Russia, a country where I unfortunately lived for four years, the 2013 “propaganda” law was written to protect children, was extended to all ages in 2022, and in 2023, a new law banned transition care for adults. The LGBT movement was then labeled as an “extremist organization,” and in 2024 Russia put it on the same government list of terrorists and extremists as Al-Qaeda. At first, Russian politicians promised that LGBT adults wouldn’t suffer and that children would be protected from the “Global West Conspiracy.” They lied. They were also saying—just like British politicians are saying right now—that trans children just need to be under the “watchful waiting” before making a decision about transitioning.

If the benefits of waiting were true, I would have had a perfect childhood. But I didn’t. My childhood was hell.

I know I’m not alone. As an adult and an LGBT activist, I have met a lot of trans young people. And they all shared the same trait: not a single one of them wanted to wait.

Ayman Eckford is a freelance journalist and a trans-masculine, non-binary person who was born in Donetsk, Ukraine, and now lives in Sheffield, UK. They have been published in the Washington Blade, Tagg, Queer Majority, Bi.org, OC Media, the Moscow Times, Diva, and other outlets, and they began their media career writing in English for the Ukrainian think tank Solid Info, focusing on gender and sexuality.

There is just one small issue.

You look like this…

Despite being your usual charming self during the interview, you can tell almost immediately that you aren’t getting much warmth back. A week later comes the perfunctory email: Thank you for interviewing. We had many excellent candidates. We’ll keep your application on file for future opportunities.

Of course, you’ll never know why you didn’t get the job. No prospective employer is going to write, We didn’t hire you because you’re trans. Or even because they thought you might be trans. There could easily have been a more qualified applicant, or any of dozens of intangible factors that influence a hiring decision.

You started medically transitioning two years ago. Hormones have helped. But, like many young trans women, you don’t have tens of thousands of dollars on hand for facial feminization surgery, surgery that might have helped you look more like this.

But you can’t help wondering whether things might have gone differently if your face hadn’t made your trans history so readily apparent. Or maybe you did pass: some women do have more masculine facial features. But maybe your interviewer decided to comb your social media, and found those posts where you openly talked about your transition journey.

While trans people in many Western countries are theoretically protected against discrimination in hiring and job loss on the basis of their trans identities, discrimination is rarely overt. No law can reliably detect the employer who decides not to interview or hire someone because she is perceived, or confirmed, to be trans, so long as the employer is sensible enough not to say so.

Trans people, and trans women in particular, have long suspected that this kind of covert discrimination occurs. We now have unusually direct empirical evidence that this phenomenon is real, and meaningful.

A newly released working paper by Taryn Eames, a PhD candidate in economics at the University of Toronto, shows how disclosing a trans history and not passing, separately and in combination, affect a trans woman’s chances of getting through the first stage of the hiring process.

Eames ran what economists call an audit study, the standard method for measuring hiring discrimination: send employers fictitious applications that are identical except for one detail, and count who gets called back. She sent 10,022 of them to real job postings in nine occupations across 27 German cities, some customer-facing and others behind the scenes. German job applications commonly include a photograph, giving her an unusual opportunity to manipulate how an applicant would be perceived depending on appearance, despite being otherwise equivalent on paper.

In half of the applications, she included one of thirty AI-generated images of a twenty-something woman designed to be read as cisgender. In the other half, the applications were accompanied by a masculinized version of the cis woman’s face. Examples of both are shown below.

Eames also independently varied whether the application revealed a trans history, through evidence that the applicant had previously had a male name. The result was essentially a four-way experiment: women who passed with no disclosed trans history; women who passed but whose trans history was revealed; women who did not pass but made no disclosure; and women who both did not pass and disclosed that history.

Presumed cisgender candidates received a positive response to 47.6 percent of their applications. When a more masculinized image was included, the positive response rate dropped to 43.0 percent. A similar decline, to 43.5 percent, was seen when someone’s trans status was revealed within the résumé but the accompanying photo was cisgender-passing. When the non-passing picture was accompanied by the revelation of a trans history, however, positive response rates dropped by fifteen points, to 32.4 percent, suggesting that the two penalties compound each other.

The disadvantage associated with a non-passing appearance was further magnified when the posting listed a contact person with a male name, when positions were customer-facing, and when the image was more strongly masculinized.

It is already well established that trans people experience substantial economic disadvantage compared with their cis counterparts, including higher levels of unemployment and lower earnings. There are numerous potential contributors to this, including concomitant mental health challenges that may affect educational achievement or contribute to disability.

Eames’s study isolates the discrimination itself. With otherwise identical applications, trans women, and in particular trans women who bear more obvious signs of masculinization, are more likely to be screened out early in the hiring process. Before a trans woman has even had the chance to demonstrate whether she is competent, personable, or good at her job, simply being perceived as trans can reduce her chances of getting through the door. While this paper looked solely at the impact of facial passability on receiving a callback, the effect would likely extend to other characteristics that reveal a trans history, such as a deeper voice, which may become evident during a phone or online interview.

This creates a profound and vicious economic cycle. A trans woman who is already struggling financially may be unable to afford the interventions that could make her trans history less immediately apparent. If being visibly trans then reduces her chances of obtaining better-paid employment, the very economic disadvantage that prevents her from accessing those interventions may help perpetuate that disadvantage. The stresses of downward economic mobility, combined with the challenges of navigating the world as a trans woman, can lead to worsening mental health, further decreasing competitiveness for employment and increasing the likelihood of long-term unemployment, deepening poverty, and increased dependency on the state.

The state has a well-established interest in providing assistance to people who face modifiable barriers to obtaining employment, helping them become more employable so they can re-enter the workforce. Governments already make considerable investments in physical rehabilitation, mental health support, vocational retraining, wage subsidies, and employment-support programs. Non-passing trans women may face an unconventional barrier to employment, but, as Eames demonstrates, it is both real and consequential. It is also a barrier that is modifiable, most notably through interventions like facial feminization surgery and voice training.

We know that FFS is highly effective at helping non-passing women be perceived as female. A 2020 study in the Aesthetic Surgery Journal found that FFS raised the share of viewers who identified a trans woman’s face as female from 57 percent before surgery to 94 percent after. While facial feminization surgery is often framed as cosmetic, given Eames’s findings, it may have economic benefits as well. A 2026 cost-effectiveness analysis in Plastic and Reconstructive Surgery estimated that FFS costs approximately US$44,000 per quality-adjusted life-year gained, the standard unit health economists use to compare treatments, which is well within conventional U.S. thresholds for cost-effective health care. The same analysis notes that FFS is the most commonly denied gender-affirming procedure. The cost-effectiveness may be even more pronounced when considering the indirect benefits of improving employability.

A number of U.S. states currently cover FFS under their Medicaid programs, and many private insurers have extended this coverage as well. But coverage for FFS lags behind coverage of hormone therapy and bottom surgery. Collecting the economic data necessary to demonstrate the impact of FFS on subsequent employment and earnings may help build support for broader coverage in jurisdictions where it is not currently insured.

Eames suggests in her paper that among the solutions to this discrimination is to help potential employers recognize “a broader range of appearances as compatible with womanhood”; in other words, to overcome their prejudices against trans women, and to hope their customers are willing to do the same. While this is a reasonable aspiration, eliminating appearance-based biases against trans women would seem to be a long-term project.

More importantly, Eames acknowledges in the paper that “timely access to hormone therapy, voice therapy, surgery, and, where clinically appropriate, puberty suppression may reduce characteristics that make passing difficult.” Targeted interventions to improve passability and presentability should not be seen as merely cosmetic, but as practical and pragmatic interventions to improve the economic outlook of trans women.

Laura Targownik is a gastroenterologist and professor of medicine at the University of Toronto. She writes Data Driven Transsexual on Substack. Taryn Eames reviewed a draft of this essay for accuracy and supplied the images, which are drawn from StyleGAN2’s pre-generated headshots (license) and altered for the study. The author used AI tools for background research, copy editing, and checking references; the text is her own.