Sarah Barringer, University of Iowa

Restrictions on medical care for transgender youth assume that without the ability to medically transition, trans people will vanish.

As of 2024, 26 U.S. states have banned gender-affirming care for young people. Less than a month into office, President Donald Trump issued numerous executive orders targeting transgender people, including a mandate to use “sex” instead of “gender” on passports, visas and global entry cards, as well as a ban on gender-affirming care for young people. These actions foreground the upcoming Supreme Court case of U.S. vs. Skrmetti which promises to shape the future of gender-affirming health care in the U.S., including restrictions or bans.

History, however, shows that withholding health care does not make transgender people go away. Scholarship of medieval literature and historical records reveals how transgender people transitioned even without a robust medical system – instead, they changed their clothes, name and social position.

Surgery in medieval times

Surgery was not a widespread practice in the medieval period. While it gained some traction in the 1300s, surgery was limited to southern France and northern Italy. Even there, surgery was dangerous and the risk of infection high.

Cutting off fleshy bits is an old practice and, potential dangers aside, removing a penis or breasts wasn’t impossible. But amputating functioning limbs was nearly always a form of punishment. Medieval people, including surgeons and patients, likely would not have had positive views of surgery that involved removing working body parts.

Surgeons in the 14th century were increasingly thinking about how to perform surgery on those with both male and female genitalia – people now called intersex. But they thought about this in terms of “correcting” genitalia to make it more apparently male or female – an attitude still present today. Historically, the procedure was probably performed on adults, but today it is usually performed on children. Both then and now, the surgery often disregards the patient’s wishes and is not medically necessary, at times leading to complications later. For patients deemed female, excess flesh could be cut away, and for patients deemed male, the vulva could be cauterized to close it.

There is, however, at least one historical example of a transgender individual receiving surgery. In 1300, near Bern, Switzerland, an unnamed woman was legally separated from her husband because she was unable to have sex with him. Soon after, the woman headed to Bologna, which was the surgery capital of Europe at the time. There, a surgeon cut open the woman’s vulva, revealing a penis and testicles. The account ends, “Back home, he took a wife, did rural work, and had legitimate and sufficient intercourse with his wife.”

The story presents the possibility of medical transition, possibly even a desire for it. But given the limits of surgical techniques and ideologies at the time, these forms of medical transition were unlikely to be common.

Transitioning without medicine

To transition without medicine, medieval transgender people relied on changes they could make themselves. They cut their hair, put on different clothes, changed their names, and found new places in society.

In 1388, a young woman named Catherine in Rottweil, Germany, “put on men’s clothes, declared herself to be a man, and called herself John.” John went on to marry a woman and later developed breasts. This caused some initial consternation – the city council of Rottweil sent John and his wife to court. However, the court did not see breasts as inhibiting John’s masculinity and the couple went home without facing any charges.

In 1395, a transgender woman named Eleanor Rykener appeared before a court in London, England, after she was caught working as a prostitute. The court clerk wrote “that a certain Anna … first taught [her] to practice this detestable vice in the manner of a woman. [She] further said that a certain Elizabeth Bronderer first dressed [her] in women’s clothing” and later she took on work as an embroideress and tapster, a sort of bartender. The account is Rykener’s own, but the court clerk editorialized it, notably adding the phrase “detestable vice” in reference to prostitution.

Rykener’s account reveals that there were a number of people interested in helping her transition – people who helped her dress, taught her how to behave, provided her employment and supported her choice of a new name. Community was a more important part of her transition than transforming her body. Based on the record, she apparently did not make an effort to create breasts.

Another account appeared in 1355 in Venice, Italy, concerning Rolandina Ronchaia. While John declared himself male, and Rykener was very active in her transition, Ronchaia’s transition was spurred on by the perceptions of others. She argued that she had always had a “feminine face, voice and gestures,” and was often mistaken for a woman. She also had breasts, “in women’s fashion.” One night, a man came to have sex with her, and Ronchaia, “wishing to connect like a woman, hid [her] own penis and took the man’s penis.” After that, she moved to Venice, where, although she continued to wear men’s clothes, she was still perceived as a woman.

Ronchaia’s account is unique because it emphasizes her body and her desire to change it by hiding her penis. But this was still a matter of what she herself could do to express her gender, rather than a medical transition.

A long transgender history

The accounts of medieval transgender individuals are limited – not only in number but in length. A lot of things did not get written down, and people were not talking about transgender people the way we are now.

Historical accounts of transgender individuals are almost always in court records, which reflect the concerns of the court more clearly than the concerns of its subjects. The court was especially worried about sexual activity between men, which both overemphasizes the importance of sex in medieval transgender people’s lives and often obscures that these accounts are even about transgender people. Eleanor Ryekener’s account frequently misgenders her and refers to her as “John.”

But it’s clear that transgender people existed in the medieval period, even when medical care was unavailable to them.

It is also the case that many of these individuals – Rykener is a likely exception – were probably intersex, and their experience would be different from those who were not. Intersex people were legally recognized and allowed some leeway if they chose to transition as an adult. This is starkly apparent in an account from Lille, France, in 1458, where a transgender woman was accused of sodomy and burned at the stake. She claimed “to have both sexes,” but the account says this was not the case. While being demonstrably intersex may not have saved her, that she claimed she was is telling.

Gender transition has a long history, going even further back than the medieval period. Then as now, the local community played a vital role in aiding an individual’s transition. Unlike the medieval period, most modern societies have far greater access to medical care. Despite current restrictions, transgender people have far more options for transition than they once did.

Medieval modes of transitioning are not a solution to current denials of medical care. But medieval transgender lives do illuminate that transgender people will not vanish even when the legal and medical systems strive to erase them.

Sarah Barringer, Ph.D. Candidate in English, University of Iowa

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Sachin Rustgi, Clemson University

U.S. consumers often pay more for gluten-free products, yet these items typically provide less protein and more sugar and calories compared with gluten-containing alternatives. That is the key finding of my new study, published in the journal Plant Foods for Human Nutrition.

This study compared gluten-free products with their gluten-containing counterparts, and the findings suggested that many perceived benefits of gluten-free products – such as weight control and diabetes management – are exaggerated.

Currently, many gluten-free products lack dietary fiber, protein and essential nutrients. Manufacturers often add supplements to compensate, but the incorporation of dietary fibers during processing can hinder protein digestion.

In addition, gluten-free products generally contain higher sugar levels compared with other products containing gluten. Long-term adherence to a gluten-free diet has been associated with increased body mass index, or BMI, and nutritional deficiencies.

Gluten-free products – defined in the U.S. as those that contain less than or equal to 20 parts per million of gluten – largely lack wheat, rye, barley and sometimes oats, all rich sources of arabinoxylan, a crucial nonstarch polysaccharide. Arabinoxylan provides several health benefits, including promoting beneficial gut bacteria, enhancing digestion, regulating blood sugar levels and supporting a balanced gut microbiota.

Our study also pointed out that it is difficult to find a gluten-free product that excels in all nutritional areas, such as high protein and fiber content with low carbohydrates and sugar.

On the other hand, gluten-free seeded bread contains significantly more fiber – 38.24 grams per 100 grams – than its gluten-containing counterparts. This is likely due to efforts by manufacturers to address fiber deficiencies by using ingredients such as pseudo-cereals, such as amaranth and quinoa hydrocolloids – meaning water-soluble macromolecules used in gluten-free baked goods made with quinoa flour.

These improvements, however, vary by manufacturer and region. For example, gluten-free products in Spain tend to have lower fiber content than their gluten-containing counterparts.

Why it matters

The term “gluten-free diet” has become a buzzword, much like “organic,” and is now a part of everyday life for many people, often without a full understanding of its actual benefits. While a gluten-free diet is a medical necessity for people who are sensitive to gluten, a condition called celiac disease, or for those with wheat allergies, others adopt a gluten-free diet due to perceived health benefits or because it’s a trend.

In 2024, the global gluten-free product market was valued at US$7.28 billion and projected to reach $13.81 billion by 2032. The U.S. market share is estimated to be $5.9 billion – a little less than half of the global figure.

Approximately 25% of the U.S. population consumes gluten-free products. This figure is far higher than the the roughly 6% of people with non-celiac wheat sensitivity, 1% of people with celiac disease and even lower percentages of people with wheat allergies.

This suggests that many people adopt gluten-free diets for reasons other than medical necessity, which may not offer health or financial benefits.

What’s next

Investment in research and development is essential to create more nutritionally balanced gluten-free products using locally available ingredients. This will require human feeding trials with different formulations of gluten-free products to ensure that these products meet nutritional needs without adverse effects.

Collaborations between governments could help secure subsidies, which would reduce production costs and make these products more affordable. Although the initial costs of research and maintaining a gluten-free production line are high, using local ingredients and financial incentives can make these products more cost-competitive compared with their gluten-containing counterparts.

Public education is also important to keep people informed about the pros and cons associated with a gluten-free diet.

The Research Brief is a short take on interesting academic work.

Sachin Rustgi, Associate Professor of Molecular Breeding, Clemson University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Francisco I. Pedraza, Arizona State University; Jason L. Morín, California State University, Northridge, and Loren Collingwood, University of New Mexico

One of President Donald Trump’s major promises during the 2024 presidential campaign was to launch mass deportations of immigrants living in the U.S. without legal authorization.

The U.S. Immigration and Customs Enforcement agency has said that, since January 2025, it is detaining and planning to deport 600 to 1,100 immigrants a day. That marks an increase from the average 282 immigration arrests that happened each day in September 2024 under the Biden administration.

The current trend would place the Trump administration on track to apprehend 25,000 immigrants in Trump’s first month in office. On an annual basis, this is about 300,000 – far from the “millions and millions” of immigrants Trump promised to deport.

A lack of funding, immigration officers, immigration detention centers and other resources has reportedly impeded the administration’s deportation work.

The Trump administration is seeking US$175 billion from Congress to use for the next four years on immigration enforcement, Axios reported on Feb. 11, 2025.

If Trump does make good on his promise of mass deportations, our research shows that removing millions of immigrants would be costly for everyone in the U.S., including American citizens and businesses.

Food costs will increase

One important factor is that mass deportations would weaken key industries in the U.S. that rely on immigrant workers, including those living in the U.S. illegally.

Overall, immigrants without legal authorization make up about 5% of the total U.S. workforce.

But that overall percentage doesn’t reflect these immigrants’ concentrated presence within various industries. Approximately half of U.S. farmworkers are living in the country without legal authorization, according to the U.S. Department of Agriculture.

Some of these immigrant farmworkers are skilled supervisors who make decisions about planting and harvesting. Others know how to use and maintain tractors, loaders, diggers, rakers, fertilizer sprayers, irrigation systems, and other machines crucial to farm operations.

If those workers were to be suddenly removed from the country, Americans would see an increase in food costs, including what they spend on groceries and at restaurants.

With fewer available workers to pick fruits and vegetables and prepare the food for shipment and distribution, the domestic production of food could decrease, leading to higher costs and more imports.

National estimates of the restaurant and food preparation workforce, meanwhile, indicate that between 10% and 15% of those workers are immigrants living in the U.S. illegally.

Past state-level immigration enforcement policies offer an idea of what could happen at the national level if Trump were to carry out widespread deportations.

For example, a 2011 Alabama law called HB-56 directed local police officers to investigate the immigration status of drivers stopped for speeding. It also prohibited landlords from renting properties to immigrants who do not have legal authorization to work or live in the country. That law and its resulting effects prompted some Alabama-based immigrant workers to leave the state following workplace raids.

Their departure wound up costing the state an estimated $2.3 billion to $10.8 billion loss in Alabama’s annual gross domestic product due to the loss of workers and economic output.

Other industries that rely on immigrants

Part of the challenge of mass deportations for industries like construction, nearly a quarter of whose workers are living without legal authorization, is that their workforce is highly skilled and not easily replaced. Immigrant workers are particularly involved in home construction and specialize in such tasks as ceiling and flooring installation as well as roofing and drywall work.

Fewer available workers would mean slower home construction, which in turn would make housing more expensive, further compounding existing problems of housing supply and affordability.

Shocks from deportations would also slow commercial and public infrastructure construction. Six construction workers, for example, died in April 2024 in the sudden collapse of the Baltimore Key Bridge in Maryland. All of them were Latino immigrants living in the U.S. without legal documentation.

Examining the arguments

Trump administration officials and other politicians have argued that deporting large numbers of immigrants would help the country save money, since fewer people will use federal and state funds by attending public schools or receiving temporary shelter.

Trump said in November 2024 that there is “no price tag” for large-scale deportations.

“It’s not a question of price tag,” Trump said. “We have no choice. When people have killed and murdered, when drug lords have destroyed countries, and now they’re going to go back to those countries because they’re not staying here,” Trump told NBC News.

Trump and his supporters also argue that deporting immigrants would mean more jobs for American workers.

But there is compelling evidence to the contrary.

First, immigrants are filling labor shortages and doing jobs that many Americans don’t want to do, ones that might be unsafe or poorly paid.

Even if Americans were willing to do those jobs, there simply aren’t enough Americans in the workforce to fill existing labor vacuums, let alone an enlarged one following deportations.

Second, for employers, having fewer workers in the country translates into higher wages, which in turn means less capital to adapt and grow. For businesses based on consumer debt – think mortgages, car loans and credit cards – deportations would disrupt the financial sector by removing responsible borrowers who make consistent payments.

Third, immigrants living without legal documentation in the U.S. pay more than $96 billion in federal, state and local taxes per year and consume fewer public benefits than citizens.

Immigrants without legal authorization are not eligible for Social Security benefits and can’t enroll in Medicare or many other safety net programs, such as the Supplemental Nutrition Assistance Program.

The bottom line

In other words, people who are living and working in the U.S. without legal authorization are helping to pay, through taxes, the costs of caring for Americans as they age and begin to draw on the nation’s retirement and health care programs.

The burden from recent inflation notwithstanding, an economy supported by immigrants living illegally in the U.S. protects Americans.

The U.S. would be unable to dodge the economic shocks and high costs that mass deportations would bring about.

Francisco I. Pedraza, Professor of political scinece, Arizona State University; Jason L. Morín, Professor of Political Science, California State University, Northridge, and Loren Collingwood, Associate Professor of political science, University of New Mexico

This article is republished from The Conversation under a Creative Commons license. Read the original article.