Trump administration recycles tired lies with cowardly attacks on medical care for trans youth
In one of his first executive orders of his second term as American president, Donald Trump established a plan to "restore biological truth to the federal government” using a third grader’s misunderstanding of basic development and physiology. His ultimate goal was to eliminate sociopolitical recognition of transgender and intersex people.
Eight days later, another executive order extended that plan by purporting to eliminate the ability of trans adolescents to access medical care that affirms their self-identified sex/gender. This second order also tasked the Secretary of Health and Human Services (a since-confirmed Robert F. Kennedy, Jr.) with drafting “a review of the existing literature on best practices for promoting the health of children who assert gender dysphoria,” derisively claiming trans youth are simply confused.
Today, the federal government released that report, as teased earlier this week. It is supposedly written by 8 experts, but in a (not-so) stunning act of cowardice we aren’t privy to their identities. Instead, the report simply bylined by “The Department of Health and Human Services,” So until we hear otherwise, I will assume that Kennedy, Jr.’s brain worm authored the report.
In terms of content, the report contains nothing new or revelatory. It largely resembles other pseudoscientific anti-trans screeds such as the UK’s Cass Report and Florida’s report on trans care, both of which have been debunked by experts at Yale (here and here).
By design, the report is too long to work through in a line-by-line fashion (at least in this venue). But it starts by reasserting the idea of “rapid onset gender dysphoria,” a form of the debunked social contagion theory. Pure hysteria and moral panic drives the hand-wringing over rapid onset gender dysphoria.
As the report shifts to considering the evidence around affirming care for trans adolescents, the authors admit that “evidence for harms associated with pediatric medical transition in systematic reviews is also sparse.” Sparse is relative because more and more research is coming out showing that puberty blockers improve the health of trans youth — from mental health to cardiorespiratory fitness. However, the report attempts to discount this evidence because it does not comport with their personal biases.
It is also important to consider what was NOT considered evidence for the purposes of this review: the stories of trans youth themselves. By focusing only on “systemic reviews” (a scientific abstraction removed from any single study), these stories get left out. Again, this is by design. A corollary of the social contagion theory is that trans-identifying youth are simply confused and lost in a cultural fad. Therefore, the knowledge that they have of themselves is overridden by a patriarchal sociopolitical authority.
It’s not that evidence of this is completely absent from the scientific record. Recent research has clearly demonstrated that state level restrictions on affirming care for trans youth are associated with 72% increases in suicidality. (Note: If you or a loved one is struggling with self-harm or suicidal ideation, please contact hotlines through the Trevor Project or Trans Lifeline. I no longer recommend that queer folx call the National Suicide and Crisis Lifeline, 988.)
In addition, the report places a lot emphasis on the existence of “regret” by some who have attempted gender transitions. In reality, the rate of stopping transition care is very low - about 3% of all people who ever identify as trans. And an even smaller fraction of that group experiences true regret.
Rather than go with the safe and effective affirming care model, the report suggests just sending trans and gender non-conforming youth to psychotherapy. Therapy can be great, but only when it engages and respects a person’s understanding of themself. I doubt that’s what HHS has in mind. Rather, they are likely to expand the reach of discredited conversion therapy practices.
This is a disservice to youth by asking them to return to the closet and try to forget their own self-knowledge. In the meantime, these adolescents will be subjected to an unwanted puberty because a group of men (and at least one brain worm) chose violence.
Yes, these restrictions on access to affirming care are just that — violent.
Ultimately, this report is an unserious and bad faith work of scholarship. This report and the regime’s attacks on the basic dignity of trans and gender non-conforming people are fundamentally pseudoscientific. They not only deny the basic studies showing the safety and efficacy of trans medical care but also invalidate the lived experiences of trans people of all ages whose lives have been enriched through access to these medical approaches.
Further, their entire argument is underpinned by the false notion that sex/gender is immutable and conferred at the moment of conception rather than an amorphous and malleable tapestry that changes slightly with each moment. Trans people are just a more dramatic embodiment of this reality given that we transgress the boundaries of our sex assigned at birth.
Yet, cis people also seek out medical interventions (hormone therapies, cosmetic surgeries, etc.) that reinforce their internal understanding of their desired sex/gender. Just one look a shirtless RFK Jr. after years of insane testosterone replacement regimen is enough to dispel any notions that these people are concerned about the “lack of evidence” around gender affirming care.
In preparation for the release of this report, I have been reflecting upon my own childhood and the onset of my feminine self-knowledge. When I was three, I sat on an ugly green booth attached to our kitchen table, chattering away with my parents in a small suburb of a mid-sized Midwest city.
Somehow, the conversation turned to puberty, and my parents began listing off the bodily changes I could expect when I hit that age: deeper voice, getting taller, the growth of body hair, etc. That sent 3-year-old Ev into a rage. I didn’t want body hair! ICK.
I shared this discomfort with my conservative Catholic parents and told them that I didn’t want this puberty thing (or, at least the one they described). They both chuckled in response: “There’s nothing you can do to stop it. And, you’re going to get it bad because look how much body hair your dad has!”
And so, I stuffed my discomfort deep down inside of myself until I was convinced it no longer existed. (Spoiler alert: It was still there, and it would resurface nearly 20 years later.) When I hit puberty and almost immediately developed depression, I was just as confused as anyone.
Now, I can’t ignore how the two (my testosterone-driven puberty and my depression) are interconnected. It’s hard to escape the fact there was a way to stop that unwanted puberty from ever occurring. I think about all the distress and turmoil that could have been avoided if my parents believed my 3-year-old self-knowledge and/or if I had access to puberty blockers as an adolescent.1
And then I think about the trans youth of today whose access to these basic needs are being ripped from them in the name of cruel politics. They deserve better than this. They deserve to live their lives with the freedom of self-expression that is granted to cis youth. They deserve transition.
from the archive
Although, I doubt my parents were aware that puberty blockers or trans people even existed, and I don’t blame them for their lack of knowledge. They have been very supportive of me since coming out.
Since the study doesn’t list who the authors were, I’m going to make some up since none are listed:
“Trump, Brainworm, Dipshit, Slacknutz, McLargehuge, et al.”