Gender-Affirming Care Gave Me a Life I Love. Why Do Pundits See It as a Tragedy?

On the day I left for a much needed vacation last month, I woke up to yet another op-ed in The New York Times praising restrictions on access to gender-affirming medical care for trans adolescents. This time from David Brooks. Thankfully, I did not fixate on Brooks’s piece while I was away, but I did have space and time to sit in my body — a body made whole by the very medical care many now seek to ban.

The work that I do, challenging anti-trans laws and policies around the country, demands that I often separate myself from my body. When one’s body is at the center of the social and political struggle on which one works, there can be a necessary fragmentation. For me, that means tackling the intellectual battles and sometimes relegating their bodily toll for another day. As I have gotten older, I have learned the value of breaks from work. And in those breaks, I have the space to access the freedom that I feel inside the body that once trapped me in misery. At the end of last month, after a grueling period of work, I spent a week in New Mexico, hiking, eating, taking in adventure, pleasure, beauty.

When I was younger, this type of joy eluded me. I carried around the weight of being fractured inside myself. I didn’t have the tools to imagine a future because I was tormented by the absence of a map of who I was and could be. In my early 20s, I thankfully met other trans masculine people, learned about gender-affirming medical care and found my way to myself. Trans people often refer to gender-affirming medical care as “lifesaving.” For me, I can say, it gave me the life that I have. One of confidence, joy, pursuit. It gave me a life I wanted to live. And the space that I never had before to be a model for others.

The more in touch I am with how hard I fought for this presence in my body, the more painful it is to contend with the current discourse over our health care.

In his recent Times piece, Brooks refers to conversations about this medical care as “one of the most toxic debates in our culture.” Perhaps it feels toxic because it should not be a debate at all. Certainly not one relegated to the self-aggrandizing ponderings of op-ed writers. The ostensible point of the piece is to praise a recent report from Hilary Cass in the U.K. for what he claims is its “epistemic humility” and “integrity.” The details of Cass’s report, the underlying evidence she examined, and the impact of its proposals are left unexplored in Brooks’s piece. But in his lead-up to discussing Cass’s report, Brooks offers a skewed and unsupported summary of the context of his discussion.

First, he writes, “This issue begins with a mystery.” The mystery he claims is that of a “skyrocketing” number of adolescents seeking to, in his words, “medically change their sex.” But this is misleading on multiple accounts.

It is not, in fact, a mystery, that increased visibility and acceptance lead to more people exploring and understanding their identity. Similar trends have been noted in numbers of out LGB youth after the legalization of marriage equality and the numbers of left-handed people after it stopped being systematically punished.

As one group of Dutch researchers note, “in the past it was harder to find information about [gender dysphoria] and its treatment…. Currently, owing to media attention and the internet, it is easier to access information about our gender identity clinic, making the threshold lower to search for help.”

But that doesn’t mean that an increased percentage of people who present to gender clinics are provided with medical interventions. Nor is it unusual for sex ratios of a condition to shift overtime. Brooks highlights the increase of those assigned female at birth as another part of the mystery. But context is important. Many conditions were previously thought to only, or mostly, impact birth-assigned males and sex ratio shifts are common with increased understanding of how gender bias affects diagnostics. This has also been true for ADHD and autism spectrum disorder in addition to gender dysphoria.

Second, Brooks frames the medical conversation around this care as one in which “name-calling” and “bullying” prevent the reasoned assessment of evidence. Most of the examples given are anonymous or reference social media posts. This type of uncorroborated and hyperbolic suggestion of chilled discourse would not normally be sufficient for The New York Times but seems to be commonplace for publication on this topic.

By contrast, when the same claims were raised by the government’s proffered “experts” in trial over Arkansas’s ban on gender-affirming medical care for minors, no examples of dissenting views being suppressed could be given on cross-examination. While it is likely that people post toxic comments on social media on this and many other topics, that is not the same as scientific debate being stifled in medical conference spaces.

The framing here matters because it feeds into conspiratorial impulses around trans people. Because of people’s reflexive discomfort with us, these impulses are able to flourish. It is easier to imagine a vast conspiracy pushing kids to be trans than to question the gender binary. That is why, despite being a tiny minority of people, trans people are given outsized attention and blamed for social ills. We pose a threat to the status quo, which is dependent on maintaining a rigid gender binary. This is also why our voices are so minimized in this current “debate.” It has to remain a debate at the level of abstraction so that people can continue to distance themselves from the possibility that our bodies are mutable and that that is beautiful, not threatening.

In a recent defense of the Times’s coverage of trans people, A.G. Sulzberger, chair and publisher of The New York Times, said, “Many of the critiques [of the coverage] are not focused on the facts we’ve reported but on the impact those facts could have in the wrong hands.” But that is a straw man. It is not about the coverage getting into the “wrong hands,” it is about the coverage being in the service of power that pushes a particular narrative of transness. It is about a lack of context to the questions asked. The Brooks piece is a perfect example. There are few references and myriad assumptions but no fleshing out of the context in which trans people have long been persecuted and situated as a threat to others. The problem isn’t that the piece will get into the wrong hands, it is that the hands that have directed us to ask these questions have remained unmentioned.

Situating access to medical care as a “toxic debate” allows a wary readership to distance themselves from their bias. The Times gives them cover to give in to their fears and abandon their critical instincts.

Those who question trans people’s right to health care often say they are concerned about its effects on our bodies. Our scars are cast as mutilation. Our gender affirmation is cast as an affront to biology.

But what if, for every article questioning this care, came an article from someone like me, someone who has been able to live a full, beautiful, joyful life because of those scars, those “affronts” to biology. It might be harder to credit the ongoing attacks if we were the ones allowed to tell the story of our lives and bodies.