Informed consent means that a trans person could access gender-affirming care without any need for mental health treatment or a lengthy assessment process. This model is routine in the vast majority of all non-transgender medical care. Cisgender people routinely access similar hormonal medications as trans people without a mental health diagnosis for conditions like polycystic ovarian syndrome, precocious puberty, menopause, loss of virility with age, and birth control.
Many doctors worldwide use a gatekeeping approach to gender-affirming care, but the informed consent model for transgender hormone replacement therapy is also widespread in the United States—a map of IC providers created by activist and journalist Erin Reed lists nearly 1,000 such providers in this country. This has been the result of decades of advocacy by the trans community to have our healthcare approached similarly to other comparable treatments.
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How do we know that informed consent works better? Well, to start, granting trans people significant levels of autonomy over their medical care is in line with the ethics of the medical profession, which directs doctors to engage in shared decision-making and uphold client autonomy whenever possible. As Bryan Murray puts it in a piece for the American Medical Association Journal of Ethics, “Informed consent is at the heart of shared decision making—a recommended approach to medical treatment decision in which patients actively participate with their doctors.” Scholar Madeleine Lipshie-Williams points out that the gatekeeping mode for gender-affirming care is at odds with how the majority of medicine is practiced in the U.S.: “[the gatekeeping model], which requires medical professionals to provide official opinions on a trangender patient’s readiness to accept and undergo care, stands in contrast to the majority model of medical consent in the US.” Lipshie-Williams also argues that the informed consent framework is preferable because it is necessary for the normalization of trans identities: “there cannot be a depathologizing of transgender identity as long as transgender individuals are required to be seen by mental health specialists to confirm both the validity of their own self-proclaimed identity, as well as their mental fitness to consent to medical interventions that have been broadly accepted as necessary. There is an inherent contradiction in declaring medical care necessary whilst simultaneously maintaining that those for whom it is necessary continue to lack the capacity to consent to this care without assistance.”
In Assigned Media
Only two weeks ago Assigned Media shared a story originally reported by the Salt Lake Tribune about a junior varsity cisgender basketball player who’d been publicly accused by an enraged parent of being trans. Last night a new story in the Salt Lake Tribune, about an entirely different cisgender athlete, shows the escalating violence of the moral panic over transgender participation in sports.
A picture of this student was shared by a far-right state school board member, Natalie Cline, who insinuated she was transgender, which in turn incited threats against the girl from Cline’s follower base. She is now under police protection, and the post has been removed.
Quick question, hotshot: Which political party in the U. S. is more likely to believe gender is fluid? If you think it’s the Democrats, the guys more closely associated with LGBTQ+ rights, you’d be incorrect. More and more, Republicans are claiming that gender identity is not just fluid but so incredibly fragile that even hearing about the possibility of non-cis identities existing poses a serious risk to children.
Case in point: J. D. Vance and Marco Rubio, two whole adult male senators, who apparently believe that by asking a test question about gender on the U. S. census the government might infect teens with the notion that trans existence is possible, thereby destabilizing their entire reality… or something.
In the American political landscape there is some very good news… and some lingering bad news for the transgender community. Yet another election cycle has proven that campaigning against the trans community is a loser for Republicans. While there is a ton of confusion and prejudice against transgender people, the public doesn’t consider this issue important enough to vote for Republicans (especially when Republicans are taking their rights away, as with abortion).
As in 2022, the elections in 2023 proved that anti-trans rhetoric didn’t help Republicans win anything. Transphobia was a loser in the campaign to unseat Governor Andy Beshear, it was a loser in the campaign for the Virginia state legislature, and it was a loser in many of the local school board races where it was front and center.
That’s the good news, and it is very good news. As a transgender man in Virginia, I would never downplay that because it impacted my life directly, making it very unlikely that new restrictions on my medication will come to Virginia.
The bad news, of course, is that nothing has changed yet in the states where legislation targeting trans people made the most headway. We’ve seen bans and restrictions on transition medicine (including for adults in some places), schools banning books with LGBTQ+ characters, and laws removing the ability of trans people to update their documents to reflect their transitions. In addition to these bad laws there are ongoing efforts to use lawsuits against providers of transgender healthcare to drive providers out of the field and make obtaining treatment more difficult for everyone, even in blue states.