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By the Fall of 2022 I had more or less completed ethnographic fieldwork on care for transgender young people in New York City, but I was still following relevant news topics on social media. The latest piece to gain traction had been a New York Times article called, “They Paused Puberty, but is there a Cost?,” which many of my interlocutors saw as misrepresenting the state of clinical practice and the risks involved in Gender Affirming Care. While visiting family in Michigan that fall, I overheard the following exchange between two relatives:
“I was wondering if you saw that New York Times article this week on transgender children’s healthcare? What did you think of that?”
The other relative, a pediatrician who recently began facilitating medical adolescent gender transitions, responded that the article in question seemed to exaggerate the severity of medical risk involved.
“But aren’t there risks to bone density or something like that?”
“Well, yeah, but I’ll run some tests first to see if they’re a good candidate for treatment and monitor them through their transition. A lot of similar risks are associated with things like birth control, and we don’t do the same monitoring tests when we prescribe that.”
The exchange was innocuous enough, but my relative’s response highlights an important dimension of public discourse on transgender pediatric and adolescent medicine: few other fields of medicine receive the same intense popular scrutiny. There are medical questions to be asked about things like GnRH agonists, or “puberty blockers” as they are sometimes called, but they are rarely framed as medications developed for cisgender children experiencing precocious puberty, which is what they are. Instead, these concerns are solely reserved for discussion of trans patients. Furthermore, coverage of trans healthcare often presents proponents and opponents as equivalent positions when most relevant medical associations endorse Gender Affirming Care.
That articles like this are framed as “just asking questions” while eclipsing important medical context contributes to a moral panic against trans people that has been having dire consequences. There are currently several bills in state legislatures across the United States that seek to expel trans people from various parts of public life—from restricting access to public facilities such as bathrooms, to barring transgender children from participating in school sports, to severely restricting medical transition altogether. Notably, The Missouri Attorney General cited another New York Times article as part of his rationale for a ban on trans healthcare. This has created a crisis of care for trans people, as access to medical services becomes uneven and inconsistent across state lines, while also contributing to a moral panic around transgender medicine—particularly for youth. Similar to abortion restrictions, none of these anti-trans policies appear to be particularly popular, which suggests the motivation for them lies beyond any short-term electoral strategy.
My relative’s comparison to birth control implies a parallel which I will state explicitly. Specifically, I argue that the struggle to secure trans healthcare shares with the reproductive justice movement a commitment to bodily autonomy in which the body is “a site of struggle over the intensive disalienation of mental and manual labour” (Gabriel 2020). In this sense, the stakes are not just individual access to medical care, but the regulation of gendered and sexual embodiment itself. The acute crisis that trans people currently face is reflective of a larger political reaction against bodily autonomy exemplified by things like the overturning of Roe v. Wade and the passage of FOSTA/SESTA.1 I compare the experiences of trans people and their relatives to the media coverage of trans healthcare to demonstrate the complicity of national media in stoking a moral panic that empowers reactionary political forces. This coverage amounts to promoting what Antonio Gramsci called “common sense” by disseminating numerous anecdotal, non-systematic concerns, questions, and narrative frameworks that taken together imply a need for dramatic restrictions on healthcare.
These experiences diverge dramatically from the common sense that emerges from trans-antagonist media. But the experiences of families often contradict conventional political wisdom beyond trans politics as well. For instance, contrary to the narrative of a neglected “white working class” that spurns issues like trans healthcare as a distraction from things like economic hardship, the mother of a trans woman living in the rural Northeast speculated that dealing with several personal, economic crises at once might have hastened her acceptance of her daughter:
I think I was just so crazy busy that, you know, under different circumstances my reaction might’ve been different. Hopefully not in a negative way, but um, I didn’t really have time, I think, to overthink it. To sit around and go, ‘oh, woe is me, what happened?’ I just didn’t have time. I just had too much other stuff going on, other stuff to do. If this is who you are, then this is who you are. And we’ll deal with it.
Conversely, middle-class parents who are relatively new to economic uncertainty were much more likely to express apprehension about their child’s transition. One parent drew a parallel between his experience of the 2009 financial crisis at his job on wall street with his child’s transition, for instance, since they happened around the same time and represented major transformations of his daily life. Moreover, the medical researchers I observed and interviewed were much more concerned with seeing if there was inequality in GnRH agonists than its potential side effects, which they were aware of and had protocols for addressing.
As my research shows, there is a diverse set of questions and positions on Gender Affirming Care, some more readily accepted than others. Nonetheless, parents and medical professionals alike are consistently questioning how their practices of care are social actions, whether their children will be accepted, and how to best support someone when you do not fully understand their interiority. Misrepresentative media coverage does not obviate these experiences, but it does provide justification for policies that actively harm trans people seeking support or care. Consider the situation unfolding in Missouri. After a Missouri gender clinic staffer, Jamie Reed, made unsubstantiated claims about the clinic’s care practices, Missouri’s Attorney General Andrew Bailey launched an investigation into the clinic, subsequently barred people under 18 from transitioning, and enacted insurmountable restrictions on healthcare access for transgender adults. The staffer’s claims included accusing doctors of prescribing hormone blockers to children who identify as “helicopters” or “mushrooms.” While these allegations were immediately contested, AG Bailey buttressed his investigation by citing a New York Times piece. In spite of Reed’s complaint being largely unsubstantiated, it resulted in massive restrictions on access to care.
Drawing an equivalence between these two pieces, as the AG did, is not about putting forth a cohesive narrative as much as it is about enforcing common sense. The restrictions on care are a kind of the “authoritarian means” that Gramsci says makes common sense appear to cohere. The New York Times and the blog where Reed made her claims have different standards for publication, content, and tone. Nonetheless, they both advance a set of concerns that distracts from the systematic knowledge that trans people and their families are creating about themselves, that ignores the way they come to see transition as something social. Imposing exterior “common sense” narrative frameworks, in which transgender medicine is marked as an exceptional category, both niche conservative blogs and national media alike contribute to the trans moral panic that is quickly setting precedent for draconian restrictions to accessing medical care.
This is reflective of a moment where bodily autonomy is under threat more generally, as evidenced by the overturning of Roe v. Wade, and the passage of SESTA/FOSTA. National coverage of transgender healthcare does not so much “convert” people to the anti-trans movement as it does obfuscate how bodily autonomy is at stake. As political discourse increasingly revolves around a division between “culture war” issues and everything else, it is incumbent upon anthropologists studying North America to collapse this division and show their mutual constitution.
Mikey Elster is a medical anthropologist and PhD Candidate in the Anthropology program at the CUNY Graduate Center. They are currently writing their dissertation on the ethics and politics of caring for trans young people in New York City.
Endnotes
Works Cited
Gabriel, K. (2020). Gender as Accumulation Strategy. Invert Journal, 1.
Gramsci, A. (2014). Selections from the Prison Notebooks. Edited and Translated by Quintin Hoare and
Geoffrey Nowell Smith. New York: International Publishers.
Twohey, M. and Jewett, C. “They Paused Their Puberty, but is there a Cost?” The New York Times. November 14, 2022.
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