The legislative push to restrict their rights isn’t new, but it’s gained more force in 2021.
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On Tuesday, Arkansas became the first state to bar transgender minors from receiving gender-affirming medical care. The first, but very possibly not the last: Legislators in some 20 states have introduced similar bills — which major medical associations have denounced as dangerous — and many more that would block trans children from participating in school sports in accordance with their gender identity, as Arkansas and three other states have already done this year.
Where did this political movement come from, and what are the underlying disputes? Here’s a look at how the country got here.
The making of a wedge issue
Legislation to restrict the rights of trans children isn’t new, but the speed with which it’s being introduced and approved around the country is. “Rarely has an issue that so few people encounter — and one that public opinion analysts have only recently begun to study in depth — become a political and cultural flash point so quickly,” my colleague Jeremy Peters reports.
That is by design. While the legislative wave may seem to have come out of nowhere, Mr. Peters explains that it was the product of a carefully coordinated and poll-tested campaign by socially conservative organizations looking for what may be their last foothold in the fight against L.G.B.T.Q. rights.
Why now? A combination of factors has fueled the trend, including the costly failure of bills that sought to regulate public bathrooms, a realization that women could make for better champions of restrictive trans-related laws, a new president who reversed the Trump administration’s rollback of trans rights, and last year’s Supreme Court ruling that workers cannot be fired for being gay or transgender.
Republicans are betting this will be a winning issue for them. “A lot of this stuff is being framed as dangerous for children. That harkens back to the gay rights movement,” Dan Cox, the director of the American Enterprise Institute’s Survey Center on American Life, told Orion Rummler at Axios. “And that’s a pretty effective way to get people who are sort of more moderate and middle of the road off and active on this issue.”
The big picture: “This is a manufactured fear that the politicians pushing hope will be emblematic of a too-swiftly changing culture,” Gillian Branstetter of the National Women’s Law Center told Katelyn Burns at Vox. It’s “simply a wedge issue to drive between voters of one party or another. My concern is that the wedge that these bills will drive is not between voters and a political party, but between parents and their children.”
Party politics aside, what are the debates here?
Medical care and the ‘social contagion’ theory
I’m concerned about the huge explosion in young women wishing to transition and also about the increasing numbers who seem to be detransitioning (returning to their original sex), because they regret taking steps that have, in some cases, altered their bodies irrevocably, and taken away their fertility.
In 2018, the academic journal PLOS One published a study that hypothesized the existence of “rapid-onset gender dysphoria,” a condition that causes children to suddenly identify as transgender because of peer influence. This conception of trans identity as a “social contagion” has been embraced most prominently by Abigail Shrier, a writer for The Wall Street Journal, and J.K. Rowling, who has likened gender-affirmative medical care to “a new kind of conversion therapy.”
But the study, which PLOS One corrected and apologized for, was sharply criticized as methodologically flawed and ideologically motivated, and the condition is not a term recognized by any major professional association. The number of people identifying as transgender has increased in recent years — to 1.8 percent for Generation Z, up from 1.2 percent for millennials — but many researchers say the rise reflects the growing awareness of transgender identity, both in society at large and within the medical profession, as well as greater access to care.
No one denies, however, that some people reverse their transition, or “de-transition,” for a variety of reasons. Estimates for the proportion of people who de-transition range from less than 0.5 percent to as high as 13 percent. (The numbers may vary depending on the kind of transition, which may or may not involve puberty blockers, cross-sex hormones or surgery, the last option almost always restricted to adults.)
Not all or even most de-transition stories are unhappy, as Dr. Jack Turban, a fellow in child and adolescent psychiatry at the Stanford University School of Medicine, has explained. But a small number of people who de-transition do have regrets. In Britain, a legal fight over whether minors could meaningfully consent to puberty blockers revolved around the story of Keira Bell, who began her medical transition at 16 and had a double mastectomy at 20 only to realize later that she wasn’t trans. “I was an unhappy girl who needed help,” she writes in Persuasion. “Instead, I was treated like an experiment.”
People disagree about how to balance the well-documented benefits of gender-affirmative care with the risks of medical intervention. Some experts, for example, have expressed concern that puberty blockers are not as medically benign as they are sometimes described: In some cases, they may limit options for gender-affirming surgery or cause severe skeletal problems when taken for several years, which can occur when children start puberty at a very young age.
But banning gender-affirmative care, as Arkansas has done, is a move that medical experts say will do profound harm. When trans children receive gender-affirming health care, it lowers their risk of self-harm, depression and suicide, which 30 percent to 51 percent of trans adolescents attempt.
Another view: Some trans writers, such as Andrea Long Chu and Masha Gessen, have argued that the cultural and medical discourses around transition should be grounded less in trans people’s suffering and more in their right to bodily autonomy. But having a more nuanced debate about trans care for young people, Mx. Gessen has written, would require changing its terms.
Trans children in sports
The rules on trans athletes reward cheats and punish the innocent. Letting men compete as women simply if they change their name and take hormones is unfair — no matter how those athletes may throw their weight around.
The participation of trans women in sports at the highest levels has been a subject of contention for decades. But the furor over public-school sports is more recent: The issue entered the national spotlight in 2018, when three high school runners in Connecticut who lost to two trans peers, Andraya Yearwood and Terry Miller, filed a Title IX lawsuit, which claimed that their participation deprived cisgender athletes of athletic opportunities and potential college scholarships.
What the science says: On average, men enjoy an advantage in athletics performance of about 10 percent to 12 percent over women, according to Dr. Eric Vilain, a geneticist specializing in sexual development who has advised the International Olympic Committee on policies for transgender athletes. As Dr. Vilain wrote for The Times in 2012, there is no single genetic explanation for the gender performance gap, but some sports scientists and organizations, like the I.O.C., have attributed it largely to differences in testosterone levels.
The science around transition and sports is still unsettled. Joanna Harper, a researcher and medical physicist, has found that athletic advantage effectively disappears in trans women runners who undergo hormone therapy. Other researchers have found that trans women retain part or most of their advantage after hormone therapy. The notion of testosterone as a “male hormone” and skeleton key to athletic performance has also been challenged, even deemed a myth.
While the science will continue to shift, there’s a limit to how much of the debate it can resolve. Let’s say testosterone-suppressing drugs — or some other medical intervention — were conclusively found to eliminate athletic advantage: Would trans and intersex children be required to take them before participating in public-school sports, as the Olympics require of adult athletes?
Even if transgender athletes retain some advantages, some scientists and others say they are not necessarily unfair, because all top athletes have biological quirks, like Michael Phelps’s abnormally low lactic acid levels or the Finnish ski legend Eero Mantyranta’s “magic blood” teeming with red blood cells. Complicating matters further, physical characteristics associated with maleness can be advantageous in one sport but disadvantageous in another, Dr. Vilain says.
Others contend that the costs to trans people of excluding them from sports are greater than whatever costs their inclusion might have for cisgender people — especially at the amateur level. “Where there’s no professional contracts, no money, no Olympic glory, we should be very inclusive about that,” Dr. Harper told The Times.
That sentiment has frustrated some young cisgender athletes, scientists acknowledge. “It is easy to sympathize with arguments made on both sides,” said Tommy Lundberg, a researcher at the Karolinska Institute outside Stockholm and co-author of a study finding that trans women athletes do retain some athletic advantage. “It is going to be impossible to make everyone happy.”
What’s clear, though, is that trans athletes do not pose an existential threat to women’s sports. Out of 200,000 women in college sports at a given time, only about 50 are transgender, according to Dr. Harper, and trans women simply do not dominate their events. As for middle and high schools, almost none of the sponsors of this year’s legislation could cite examples in their states where the inclusion of trans athletes caused problems.
Their legislative agenda continues to gain momentum nonetheless. On Monday, Republicans in North Carolina proposed a law that would not only bar people under 21 from receiving gender-affirmative care but also require state employees, including teachers, to report to parents any child who displays “gender nonconformity.”
Do you have a point of view we missed? Email us at [email protected]. Please note your name, age and location in your response, which may be included in the next newsletter.
“So You Want to ‘Save Women’s Sports’?” [The New York Times]
“Transgender Childhood Is Not a ‘Trend’” [The New York Times]
“When Children Say They’re Trans” [The Atlantic]
“Keeping Trans Kids From Medicine Doesn’t Make Them Disappear” [The New York Times]
WHAT YOU’RE SAYING
Here’s what readers had to say about the last edition: Vaccine passports
Bob from New Mexico: “Yes, the vaccine passport may favor the well-off unfairly, but so does a U.S. passport when compared to other countries.”
Erik from Michigan: “Justin Amash, a politician from my home state of Michigan, tweets that vaccine passports are dystopian. The definition of dystopian is a state or society where there is great suffering or injustice. However, a vaccine passport would allow people to go into a location without the fear of catching a deadly disease. It is the people who refuse to be part of the solution who are causing a dystopian state for those of us who are trying to help ourselves, our families and our fellow citizens by getting vaccinated.”