There is no legitimate 'debate' over gender-affirming healthcare

A recent New York Times article that experts called inaccurate and unethical now serves as evidence in Texas against transgender kids.

click to enlarge Advocates speak out last year against a Texas House bill seeking to limit transgender kids' participation in school sports. - Twitter / @ProgressTX
Twitter / @ProgressTX
Advocates speak out last year against a Texas House bill seeking to limit transgender kids' participation in school sports.
This article was originally published by the Texas Observer, a nonprofit investigative news outlet. Sign up for their weekly newsletter, or follow them on Facebook and Twitter.”

On June 15, the New York Times Magazine published “The Battle Over Gender Therapy,” an investigation into gender-affirming care for young people by staff writer Emily Bazelon. Since its publication, transgender-rights advocates, medical experts and other journalists have condemned the article for inaccurately portraying such care as controversial, misrepresenting scientific research and quoting anti-trans activists without proper context. 

Now, the state of Texas is using it as evidence in an ongoing attempt to investigate trans-supportive healthcare as “child abuse.”

In February, Attorney General Ken Paxton issued a nonbinding legal opinion that redefined gender-affirming healthcare as “child abuse,” after which Governor Greg Abbott directed the Depart­ment of Family and Protective Services to investigate trans youth and their families. Ever since, Texas has been engaged in a protracted legal battle with civil rights groups over the order. In a recent salvo, the ACLU and Lambda Legal filed suit to protect members of PFLAG, a nonprofit for families and allies of LGBTQ+ people. For the moment, the courts have blocked Child Protective Services from investigating families with trans kids as long as they are members of PFLAG. It was in these proceedings that the state used the Times article in a brief on July 6. 

“That there exists enormous controversy and disagreement among experts is itself the coverage of major media coverage including the New York Times‘The Battle Over Gender Therapy: More teenagers than ever are seeking transitions, but the medical community that treats them is deeply divided about why–and what to do help them,’” reads the brief in the state’s court case. 

The document goes on to cite a handful of assertions from the article: Chiefly, that medical authorities in countries like Sweden and the U.K. require children seeking this kind of care to undergo more rigorous screening compared with their American counterparts. Because of this, the piece suggests children may be undergoing unnecessary treatment that leaves them with lasting harm or regret in the long run.

“The National Academy of Medicine in France called for ‘great medical caution’ regarding treatment for young people, citing health risks (including for bone density and fertility) and noting the unexplained rise in trans-identified teenagers,” Bazelon wrote.

For the sake of “balance” and objectivity, Bazelon elevates a handful of outliers and their discredited theories about trans people to prominence they do not enjoy among the medical community. Deliberately or not, her article echoes right-wing fear-mongering about whether trans kids should be allowed to transition and even suggests their existence could be dangerous to other young people.

Medical professionals, trans rights advocates, and media watchdogs who spoke with the Texas Observer sharply criticized the idea that providing supportive care to trans kids is controversial. 

“The reality is that gender-affirming medical care for trans youth is not controversial within mainstream medicine,” said Jack Turban, a medical doctor and incoming assistant professor of child and adolescent psychiatry at the University of California San Francisco. “There is broad consensus from all major medical organizations that legislation outlawing it is dangerous.”

The American Medical Association, the American Psychiatric Association, the American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry are a few of the major U.S. medical organizations that have endorsed this form of health care. They have all condemned laws which block access to healthcare for trans young people. 

Turban, who researches the mental health of transgender youth, said Bazelon improperly summarized the available research on trans healthcare, including misrepresenting some of his work and that of a colleague, Dr. Amy Green. Their research has shown that those who access gender-affirming care during adolescence have lower odds of suicidality than those who aren’t able to access such care. Bazelon quotes Dr. Christine Yu Moutier, psychiatrist and the chief medical officer at the American Foundation for Suicide Prevention, who claims the difference may simply be a proxy for socioeconomic status. Turban countered that the statistical analysis his team conducted adjusted for confounding variables such as this. 

“Gender-affirming medical care for trans youth is not controversial within mainstream medicine.”

(Bazelon reached out to Turban while researching her story, though she did not interview him. In the article, she asserts that Turban “didn’t have time to talk,” but Turban said he offered to correspond with her by email while on vacation.) 

Turban’s own survey of 16 studies found strong evidence that affirming healthcare for trans youth improves mental health and saves lives.

“Taken together, the studies strongly indicate that gender-affirming medical care results in better mental health outcomes for trans youth,” he explained. 

While conceding that research shows few who undergo gender-affirming care regret their decision, Bazelon asserts that today’s trans teens are different than the transgender people of yesteryear, who she argues were more thoroughly studied. 

“How many young people, especially those struggling with serious mental health issues, might be trying to shed aspects of themselves they dislike?” she asks.

“Regret among those who receive gender-affirming care is extremely low and delaying transition until adulthood is likely to cause lasting and irreparable psychosocial harm,” said Dallas Ducar, a transgender nurse practitioner and chief executive officer of Transhealth Northampton, a Massachusetts clinic specializing in healthcare for trans people of all ages.

In reality, trans children face immense barriers to access. Many trans kids are unable to access appropriate healthcare of any kind, even routine medical and dental care, due to poverty and homelessness. Appropriate clinics or physicians may be hard to locate—or are forced to shut down under pressure from state governments. Trans young people undergo lengthy evaluations before being granted access to hormones, puberty blockers, or any other form of medical intervention. 

Bazelon’s article quotes extensively from parents involved in a group called GENSPECT, an organization that opposes gender-affirming care for young people. Some members quoted support banning transition for anyone under 25, which has become a mainstream Republican position. Bazelon noted on Twitter that the group has engaged in anti-trans activism. The article, however, presents them only as a concerned group of parents, ignoring this vital context.

“When you find yourself, in the final story, repeating the talking points of anti-trans activists without criticism, without context, then even if you don’t have an agenda, you’re advancing the agenda of the people you’re platforming,” said Heron Greenesmith, an attorney and senior research analyst at Political Research Associates who specializes in tracking how the media covers transgender people. “Emily Bazelon did a really great job of replicating their anti-trans talking points in the paper of record.”

The GENSPECT parents and others quoted by Bazelon suggest that exposure to transgender kids, education about trans people, and trans ideas on the internet could spread transness to others who might otherwise never have questioned their gender. 

“Some Genspect parents told me the rise in trans-identified teenagers was the result of a ‘gender cult’ — a mass craze,” Bazelon wrote credulously. Other sources quoted suggest their children are simply mentally ill and therefore susceptible to the idea that they might be trans or gender nonconforming. 

“One mother in Northern California said her child had previously been hospitalized for a suicide attempt and started identifying as trans while spending many hours online,” Bazelon reported.

Turban said this idea stems from a discredited 2018 study about so-called “rapid-onset gender dysphoria,” which centered the voices of parents opposed to their children’s transition. Its authors have since been criticized for failing to interview the young people or their therapists, and it has been appended with a correction noting that “‘rapid-onset gender dysphoria” is not a formal mental health diagnosis. 

“It’s true that children today are discussing their gender identities with more nuance than past generations, and more are openly identifying as transgender or non-binary,” Turban said. “They’re also less likely to hide their gender diversity from others now that we’ve reached a place where there is slightly less stigma around gender diversity.” 

Furthermore, Turban said there’s a “substantial body of literature” that points to the idea that gender identity, including trans and nonbinary identities, has a basis in biology.

“While our social environments likely impact the way we conceptualize and attribute language to our gender identities—as well as how likely we are to be open about our gender identity with others—this research suggests a strong innate biological foundation,” Turban said. 

Ducar also rejected the idea that exposure to people with trans identities could be dangerous for kids: “We cannot change someone’s gender identity, but we can make it feel unsafe for them to express their fullest version of themselves.”

Not only is social contagion a discredited scientific concept; it echoes very old forms of bigotry. 

“Contagion and child recruitment are the oldest tropes in the right-wing book,” Greenesmith said. They noted that similar rhetoric has been used against Jewish people, immigrants, and other marginalized groups. 

The Observer was unable to contact Bazelon directly, either by social media or email. In response to a detailed list of questions, spokesman Charlie Stadtlander replied: “We believe that journalism, when it is rigorously independent and fair-minded, can provide an antidote to the misinformation on which intolerance thrives.”

“To me, being a journalist means following the facts where they lead,” Bazelon tweeted on June 22 after receiving intense criticism of her article via the social network. “It isn’t advocacy. I didn’t know where this story would go when I started reporting eight months ago.”

“Contagion and child recruitment are the oldest tropes in the right-wing book.”

What is, in fact, contagious is the harm caused by skewing important scientific debates. Articles like Bazelon’s help make transphobic ideas more acceptable to a mainstream liberal audience.

“Democrats don’t listen to Fox News,” said Steven W. Thrasher, a media analyst who serves as Daniel H. Renberg Chair of social justice in reporting at Northwestern University’s Medill School of Journalism. “They do listen to the New York Times.”  

All of this could have been avoided had Bazelon listened to more experts and included more transgender people. That includes Ky Schevers and Lee Leveille, who run a trans advocacy group called Health Liberation Now! Bazelon communicated extensively with them both while working on the article, conducting interviews that were ultimately discarded. They also advised Bazelon to reach out to others, including the Trans Journalists Association, which produces a style guide for journalists reporting on trans issues. 

“It was disappointing and infuriating to see her disregard our warnings and now to learn that her article is being used as evidence to stop trans youth from accessing healthcare,” Schevers told the Observer. “This is exactly what we were trying to prevent.”

In an extensive response on their website, Leveille and Schevers accuse the Times of fueling a dangerous political debate over the existence of trans people and their ability to access supportive healthcare.

“What happened in Texas comes as no surprise to any trans person that has been keeping up with these legislative attacks over the past few years,” Leveille told the Observer. A record-breaking number of bills and policy-based attempts to restrict trans rights in the U.S. have cropped up in recent memory. Leveille said many publications, including the Times, help lay the groundwork for government persecution.

“What we are seeing now is a result of white, Christian, cis-dominant power structures devaluing the lives of anyone outside of their idea of the ‘default,’” she said. “Media as a whole, as one of the arms of that power structure, can reshape entire social narratives in ways that make or break people’s access to fundamental human rights.”

Unfortunately, we’ll keep seeing these kinds of stories appear as long as cisgender journalists approach trans rights by questioning if our existence should be supported rather than a more compassionate approach that centers our voices and asks how we can be supported. 

“Trans kids and their families deserve to live their lives without the constant scrutiny of the state,” said Leveille. “They deserve to live without erroneous claims of child abuse over a ‘debate’ that’s been fabricated just to keep trans people under institutional control.”

Correction, 7/22 12:23pm: We updated our summary of Dr. Turban and Dr. Green’s research to more accurately reflect their findings.

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