Trans rights

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.”

A really good guide to being an activist in general:

One of the most important things that trans folks need to get before their arguments can work well is that we tend to get pushed pretty hard to the political left when we come out and transition. It’s not some brainwashing thing—we just tend to be poorer, better-educated, and get hit with the shitty side of our capitalistic social structure, all of which pushes voters toward more liberal or leftist political positions. Given that we tend to hang out in groups, particularly online, we get hit pretty hard with the echo chamber effect, which reinforces socially-common political biases through self-sorting.

In simple terms? It means that by hanging out with a bunch of other trans folks, we tend to get entrenched in political stances that are common in the trans community. It’s the Fox News Grandpa effect.

And I’m guessing that it makes you feel a little uncomfortable to hear that.

This is the first and most important thing you need to face if you want to persuade people outside of your social bubble effectively: you are not immune to persuasion or propaganda. You have absorbed a lot without noticing it over the years, both before and after your transition. And those things? People have noticed them, and noticing those things has colored their view of you as a person and a rhetor.

Put a different way: if they know you have a history of arguing for what they see as hard-left stuff, stuff they think is a bad idea, they’re going to treat other things you argue for with a degree of pretty understandable skepticism.

When you can relate…

But the truth is more complicated than any before-and-after story. Testosterone didn’t suddenly turn George from girl to boy. As a young child, he was different in ways that were undefinable but palpable enough to make him an outcast. Invitations to sleepovers and birthday parties were rare. Kids thought he was strange; he thought they were incomprehensible and cruel.

George was bookish, had odd interests and was utterly ignorant of the things that captivated the girls around him. He stood outside the worlds of either girls or boys in a state of loneliness I can still hardly bear to recall. And then puberty came along and took his suffering to new levels. It was like being buried alive in a body not his own, a body suggesting roles he could in no way fathom.

Since the launch of the Cass Review in 2020, the situation for trans children in the UK has continued to decline (Madrigal-Borloz, Citation2023). In 2022 the UK Minister for Health called for clinicians to look for evidence of “what has caused children to be trans,” citing the Cass Review to claim that “identifying as trans” is likely to be a response to “child sex abuse” (Milton, Citation2022). The Cass Review was cited by the British government to justify plans to exclude trans people from legislation to ban conversion therapy (British Psychological Society, Citation2022). The Cass Review was also cited to justify the closure of existing children’s gender services for England and Wales, with services ceasing to see any new referrals 18 months before replacement services are expected to be operational (Ali, Citation2023). Trans healthcare professionals outside of the UK have critiqued the Cass review (Pang et al., Citation2022) as well as critiquing healthcare policies inspired by the Cass Review such as the NHS’ 2023 draft service specification (WPATH et al., Citation2023).

Since Republicans took control of the House of Representatives last January, GOP lawmakers on Capitol Hill have quietly added a wave of amendments to "must-pass" government funding bills that would ban federal money from being used for gender transition procedures such as hormone therapy and sex reassignment surgery.

These riders vary widely in their scope and effect. Some target government health programs such as Medicare and Medicaid. Others would revoke insurance coverage for transgender government employees. Still others would bar federal funding for any institution that "promotes transgenderism".

Taken together, though, they would drastically curtail trans people’s access to medical care that advocates routinely describe as critical to their flourishing – much as the 1977 Hyde Amendment restricted abortion access in the wake of Roe v Wade.

The posts seen by TBIJ show Bayswater parents discussing how their treatment of their trans children has led to them being reported to social services.

One posted that a school counsellor made a referral because “my [child] is fearful living in our home, we have refused to buy [them] certain (boys) clothes and we restrained [them]”. A subsequent post noted the child was “not concerned that Mum and Dad have been referred to social services”.

Members are aware that some of their behaviour is considered abuse. One user posted a link to an article about anti-LGBTQ+ domestic abuse, with the caption: “Examples include monitoring interaction with friends. Imagine it also includes refusal to affirm.”

Another parent sarcastically responded “Yes, we are abusive!”, with the original commenter retorting: “One day, they may thank us for that ‘abuse’”.

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Many Bayswater parents restrict their children’s internet access. “I knew the Internet was a major factor [in my child’s gender identity] so I (famously) drowned [their] iPhone in a jug of salty sugar water whilst [they were] in the shower one day,” posted one parent.

A suggested website blocklist on the forum includes LGBTQ+ charities like Mermaids and Stonewall, websites that sell binders, and even Childline, the NSPCC’s counselling service. 

Heartbreaking and terrifying.

“An amendment to the Schools Bill is being discussed in Parliament tomorrow,” read the post on an online forum run by the Bayswater Support Group, which describes itself as the UK’s only support organisation run by and for parents of trans children and young people.

“If passed it will allow greater transparency about what is being taught in schools. We have been contacted for a short piece of evidence,” the mother said. “Does anyone have the experience of their autistic child identifying as trans following learning about it at school? Ideally a situation where the school went onto transition the child.”

The following day, on 30 June 2022, during a parliamentary debate about relationships, sex and health education (RSHE), the Conservative MP Miriam Cates argued that learning about trans identities was damaging to children.

“One parent of a 15-year-old with a diagnosis of Asperger’s syndrome said she discovered that without her knowledge, her [child’s] school had started the process of socially transitioning her child, and has continued to do so despite the mother’s objections,” said Cates, who is standing again for her seat Penistone and Stockbridge, in South Yorkshire, in the upcoming election.

The story Cates told the House of Commons closely mirrored the request posted on Bayswater’s private channel on Discord, an online message board. She even named the group during the debate, saying it had reported “a surge” of parents contacting Bayswater after their children learned about trans people at school.

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Bayswater’s public concern about children’s safety strikes a marked contrast to posts on its Discord channel, where parents wrote of being reported to social services over “restraining” their child and called a shelter for LGBTQ+ abuse survivors “a church for the gender faithful”. A post on the forum recommended blocking children’s access to the website for Childline, the NSPCC’s counselling service.

To me, the lynchpin that enables the other problems listed here is that "LGBTIQ+ rights are [being] wedged into existing ‘culture-war’ narratives":

Media and political campaigns have positioned the rights of LGBTIQ+ people as negotiable and debatable. Some try to frame the human rights of transgender people as being at odds with women’s rights, even asserting that trans women do not face gender-based discrimination or that they pose a threat to the rights, spaces, and safety of cisgender women.

While they vary by cultural context, these campaigns often portray the push for LGBTIQ+ people’s rights as merely a generational dispute, part of a so-called “culture war”, or in some cases an imperialist agenda. 

Many such narratives position trans and non-binary gender identities as new or Western concepts, ignoring the rich history of diverse sexual orientations, gender identities, gender expressions, and sex characteristics across cultures and within the global South in particular.  

Falsely portraying the rights of LGBTIQ+ people, and particularly of trans people, as competing with women’s rights only widens divisions in the broader gender equality movement. This has given anti-rights actors space to advance rollbacks on sexual and reproductive health and rights, comprehensive sexuality education, and other critical issues.
 

In part, Ms. Conway acknowledged, she had avoided the spotlight intentionally, living in “stealth mode” for fear that her gender identity would wreck her career. It had already cost her her job once, when she was fired from IBM in 1968 after confiding to managers that she was planning to undergo gender-confirmation surgery, a then-novel procedure that she had to travel to Mexico to receive.

“In many jurisdictions, I could have been arrested and charged as a sex offender — or, worse yet, institutionalized and forced to undergo electroshock therapy in a mental hospital,” she wrote in a 2013 essay for HuffPost.

“Evading those fates, I completed my transition and began building a career in a secret new identity, starting at the bottom of the ladder as a contract programmer. Even then, any ‘outing’ could have led to media exposure, and I’d have become unemployable, out on the streets for good.”

“I covered my past for over 30 years,” she added, “always looking over my shoulder, as if a foreign spy in my own country.”

By 2000, she had decided to begin telling her story — including discussing her early research contributions at IBM, which had been lost to history because they were credited under her long-discarded birth name. She started speaking to reporters, including for a nearly 8,000-word cover story in the Los Angeles Times Magazine, and created a personal website where she aimed to offer “information, encouragement and hope” to others who had transitioned or were in the process of doing so.

On Friday, numerous conservative accounts and news sources promoted headlines that the "American College of Pediatricians" had issued a statement against transgender care. A video accompanied the announcement featuring Dr. Jill Simons, who, wearing a white lab coat, states that there must be an end to "social affirmation, puberty blockers, and cross-sex hormones" for transgender youth. Despite the official-looking attire and name, the organization's name serves to mislead observers into thinking they are the much larger American Academy of Pediatrics, which represents tens of thousands of pediatricians. In reality, the ACP is a hyper-conservative Christian group of doctors created in 2002 to oppose gay parenting.

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The American College of Pediatricians has been hugely influential in the promotion of anti-trans policy in the United States, relying in part to its misleading name. Members of the organization testify in state houses and courtrooms across the United States, misleading legislators into thinking they are the much larger American Academy of Pediatrics, the professional society that represents 67,000 pediatricians in the United States.