Three Questions for Every Paper of Record That Publishes a Story on Trans Healthcare
The defining feature of modern transgender medicine is transphobia.
Unlike many fields of medical practice, transgender medicine was deliberately intended by its architects to prevent and limit as many trans people as possible from transitioning. This is conventionally termed the “gatekeeping” model of transgender medicine, one engineered primarily in Europe and North America in the mid twentieth century. The story of how this self-limiting principle came to be and why is immensely complex, but it is the overwhelming consensus of the historians of record who have researched the field’s formation and development.[1] That premise was codified as the field’s best practices in the Harry Benjamin International Gender Dysphoria Association (HBIGDA), which today goes by the name WPATH (World Professional Association for Transgender Health).
This past week, members of the white supremacist organization the Proud Boys stormed a drag queen story hour pride event in the San Francisco Bay Area, harassing and threatening everyone in attendance. And 31 members of the far right Patriot Front were arrested separately in Idaho while en route to a pride festival in Coeur D’Alene.
How many in-depth stories were published by papers of record asking questions about the origins, character, and impact of political violence targeting queer and trans people, including the targeting of children? How many stories, by comparison, were published about the putative debate over whether trans people, especially youth, ought to be allowed to transition?
I have given more interviews than I can remember on trans healthcare’s politicization in recent years. In nearly all of them I have offered the most quotable way I know to explain to a public audience the material difference between transgender healthcare and non-transgender healthcare: the difference is transphobia. The medical resources needed to transition are not of a different species than the equally numerous ways that non-trans people’s sex and gender are routinely medicalized. Yet they are treated fundamentally differently. Although they share the same clinical and scientific history, one is treated as new, experimental, and potentially dangerous, while the other is rarely the subject of sustained news coverage at all. One is treated as always arriving too quickly, while the other is treated as so unremarkable it is as if it has always existed.
I have explained that, in my expertise as a professional historian, the foundation of the transgender healthcare we inherit today was deliberately designed to stop trans people from transitioning in most cases. It has primarily done so by establishing the narrowest of eligibility criteria possible. And the great expense of transition has kept it out of reach for most trans people regardless of whether or not they might be able to qualify under any medical model. These two primary harms remain serious for trans people to this day since that medical model still underpins contemporary institutional practice despite its many changes over the past 70 years.
But these lines seemingly always fail to make it into print.
And so, here are three questions I would like to see every journalistic account of transgender medicine ask—and answer—in its opening paragraphs:
Why is transgender healthcare a separate sub-specialty of medical practice? What makes it different from the gender affirming care that is routinely provided to non-trans people, including for off-label purposes not approved by the FDA?
(This includes, but is not limited to: hormone blockers and therapies, whether testosterone, estrogen, spironolactone, finasteride, progesterone, and puberty suppressing medications; reproductive care, including hormonal birth control, non-hormonal birth control, IVF treatment, and surgical procedures to prevent pregnancy; hair removal and hair regrowth procedures; and a wide array of plastic surgeries performed with the express purpose of improving an individual’s well-being and sense of comfort in their body, including mastectomies, breast augmentation, chest reconstructive surgeries, orchiectomies, hysterectomies, vaginoplasty, phalloplasty, testicular implants, rhinoplasties, body contouring liposuction, lip fillers, botox, and more.)Why does transgender medicine include and require extensive psychiatric evaluation for the delivery of physical medicine, including routine primary care? Why do both public and private insurance frequently require psychiatric evaluation, sometimes from up to three separate sources, to corroborate the need for medical care? Is such psychiatric evaluation required for the identical forms of medicine in non-trans people?
Why is trans healthcare now illegal for some people in certain states where the exact same procedures remain legal, by explicit legislative exception, for certain non-trans people?
It seems to me that if journalism is not presently answering such basic factual questions up front—for which there is a massive scholarly literature to turn to—then it is not doing its most basic due diligence.
The answers to these questions are complicated and likely surprising. They also require taking seriously the conclusions of historians of transgender medicine and scholars of contemporary transgender health care, who have spent decades doing the research required to answer them with a high degree of certainty and nuance. I suspect that attention to the actual history, practice, and delivery of transgender healthcare might substantially change how such stories are written—or even whether they are seen as worth writing in the first place.
[1] If you are interested in reading this historical scholarship to understand how and why, I would recommend starting here with some essential studies:
Susan Stryker, Transgender History: The Roots of Today’s Revolution (Seal Press, 2017).
Joanne Meyerowitz, How Sex Changed: A History of Transsexuality in the United States (Harvard University Press, 2004).
Stef Shuster, Trans Medicine: The Emergence and Practice of Treating Gender (New York University Press, 2021).
Aren A. Aizura, Mobile Subjects: Transnational Imaginaries of Gender Reassignment (Duke University Press, 2018).
Jules Gill-Peterson, Histories of the Transgender Child (University of Minnesota Press, 2018).
Beans Velocci, “Standards of Care: Uncertainty and Risk in Harry Benjamin’s Transsexual Classifications,” TSQ: Transgender Studies Quarterly Vol 8, No 4 (2021): 462-480.