BROOKE GLADSTONE From WNYC in New York, this is On the Media. This week, the stories behind a sweeping wave of anti-trans legislation.
KATELYN BURNS There's been many a movement in U.S. history that has been about, quote, unquote, protecting the children.
JULES GILL-PETERSON For most of the 20th century. Scientists and doctors believe that everyone was just a mix of male and female.
SYLVIA RIVERA The street people and the drag queens were the vanguard of the movement. Didn't mind getting our heads bashed in. [END CLIP]
JACK TURBAN You're gonna think, like maybe they're right, maybe I am a threat, maybe I'm confused, maybe I'm mentally ill.
SAM FEDER I want complicated stories. You know, the full picture of a trans person's life.
SUSAN STRYKER The only positive representation I saw of anything trans feminine was Bugs Bunny. [END CLIP]
BROOKE GLADSTONE Trans visibility and its discontents. It's all coming up after this.
BROOKE GLADSTONE From WNYC in New York, this is On the Media., Bob Garfield is out this week. I'm Brooke Gladstone. Transgender people are under siege, even though it may seem to some news consumers like their taking over. In fact, their very lives are increasingly at risk. And the argument over whether they even exist at all, if they're really not the gender they were declared to be at birth, still blazes. In some political quarters, it's getting hotter an hour is too short to present all the evidence showing that transgenderism is old news. You can find it in many an ancient tomb. But here in the U.S., where acceptance has ebbed and flowed, transgender people have rarely been so seen and stigmatized and so politically profitable.
NEWS REPORT A record number of restrictive bills targeting transgender kids makes their way through state legislatures. [END CLIP]
BROOKE GLADSTONE At least 117 bills in some 33 states have been introduced in the current legislative session alone. The most since the Human Rights Campaign, one of the nation's largest LGBTQ advocacy groups, began tracking such legislation more than 15 years ago.
NEWS REPORT Unless you think this is just happening in Mississippi or Arkansas, think again [END CLIP]
BROOKE GLADSTONE A few years ago banning transgender people from bathrooms that accord with their gender identity was the big thing, but it fizzled. Now it's all about sports.
NEWS REPORT Tennessee has become the third state this month to impose new laws attacking transgender student athletes, alongside Mississippi and Arkansas. [END CLIP]
BROOKE GLADSTONE OK, the campaign targeting transgender people isn't all about sports.
KATELYN BURNS They've taken a two-prong approach to it. The most successful prong so far is banning transgender girls from girls sports in school.
BROOKE GLADSTONE Journalist Katelyn Burns writes for Vox and MSNBC and is co-host of the Cancel Me Daddy podcast.
KATELYN BURNS And then the second line of attack is to try to ban transition related health care for people under the age of 18.
BROOKE GLADSTONE Burns says that all the anti trans talking points spring from a single document published in June 2015 by the Family Research Council, a Christian activist lobbying group. It was called Understanding and Responding to the Transgender Movement. It declares that, quote, no one can change his or her sex. The DNA in the body is marked clearly male or female, but we all basically start out female in the womb until the Y chromosome is activated by a gene. If it's missing or if you have a burst of an unexpected hormone or are insensitive to the usual one you won't be what the outside world may say you are. And biology aside, what's it to them? From the document, many movement activists will not be content until they compel all of society to accept their transgender fantasy. This document, by the way, is from the same group that battled marriage equality with everything it had and lost, and yet the family survived, but transgender is not a thing. Not a thing. Meanwhile, these bills are a thing.
NEWS REPORT The families of three female athletes are stepping up their fight for a level playing field. They filed a federal lawsuit challenging the policy that allows anyone who identifies as a female to compete in girls' sports. [END CLIP]
KATELYN BURNS There was two trans competitors who won almost every sporting event in Connecticut. People are saying, oh, well, they're boys, of course they're going to win and this should not be allowed. The problem is these are the only cases that can be cited at the high school level of trans girls, actually, quote unquote, dominating a sport. The AP went around and asked conservative legislators, how many complaints have there been about trans athletes in your state? And they couldn't find any. The cases that the legislators were always citing was the Connetticut sprinters case.
BROOKE GLADSTONE But if the Save Girls Sports from Trans Girls campaign has traction, why did the trans bathroom ban, born in North Carolina, peter out?
KATELYN BURNS It was one of the first times in American media history that trans people were actually given a voice. Trans people were allowed to explain why these policies were bad for them. The NBA pulled out their All-Star game from Charlotte that year. The NCAA said we're not holding any championship events in North Carolina, which is a huge deal. A later study estimated that the state lost about three point seven billion dollars in revenue just from these boycotts.
BROOKE GLADSTONE And North Carolina Governor Pat McCrory, a big proponent of bathroom sanctity, lost the election that Republicans otherwise swept
KATELYN BURNS State after state businesses say this is bad for our business. You cannot pass these bills. We do not support them. We will not support your reelection campaign if you support them. And there hasn't been another bathroom bill that's passed since then. Tennessee and Arkansas right now are both trying to again, so it's not completely dead, but this actually brings me to my next point. The fear of boycotts has been the primary driver in killing all of these anti-trans bills to date.
BROOKE GLADSTONE Remember a few minutes ago when Burns said there was a two pronged approach to the legislative assault on trans people? The second one would do far more harm than the first.
Speaker 2 One of my fears as a trans person is I don't see anybody trying to organize boycotts against Arkansas who passed probably the most horrific anti trans bill in US history with their trans youth medical ban. Walmart hasn't said a peep, Hardies hasn't said a peep. They're both based in Arkansas, and I think the conservative response to the boycott in North Carolina now is to try to get these bills passed in as many states as possible, because is a company going to pull out of the entire US south? No, they're not. Would the NCAA say, OK, we're not holding championships anywhere in the southeast US? No they will not.
BROOKE GLADSTONE Journalist Katelyn Burns writes for Vox and MSNBC and is co-host of the Cancel Me Daddy podcast. This hour, trans people, well, mostly trans people, will speak for themselves and will answer some of the questions cis people may have been afraid to ask. Dr. Jack Turban is a fellow in child and adolescent psychiatry at Stanford University School of Medicine, where he researches the mental health of transgender youth. Much of the recent spate of anti trans legislation has focused on limiting the access of trans kids to puberty blockers, often the first medical step in transitioning. He says puberty blockers have been used for decades.
JACK TURBAN When they were first used for kids, they were used for a condition called precocious puberty. And then over the past few decades, but more recently, doctors started using these for kids who are transgender. There are now protocols that are outlined by the Endocrine Society and the World Professional Association for Transgender Health that tell doctors how they can use these for transgender kids who start puberty and have really extreme and negative reactions to their bodies developing. For some kids, those psychological reactions can be really severe. So we see kids who come to the emergency room in mental health crises. They may even be having suicidal thoughts. Kids who are so dysphoric towards the way they're chests are developing that they're binding their chests so tightly that they're getting skin infections or having trouble breathing, sometimes even rib fractures. These puberty blocking medications are really spectacular because they put puberty on hold while these kids have time to figure out what's going on, and they also happen to be reversible. So if you stop the medication, the adolescent will go through the puberty that they were going to go through originally.
BROOKE GLADSTONE Is there any indication that withholding puberty blockers causes actual harm?
JACK TURBAN Our group from Harvard Medical School, working with the Fenway Institute, published a paper earlier this year that looked at people who wanted puberty blockers, who were now adults, and we compared those who were able to access the medication with those who weren't able to access the medication. And those who accessed it had lower odds of having considered suicide in their lifetime. Arkansas recently became the first state to take away these medications from transgender youth. One of the doctors who runs a clinic for transgender kids said that she's already seeing more kids attempting suicide.
BROOKE GLADSTONE What about hormones, testosterone or estrogen?
JACK TURBAN That's a bigger decision to start those medications. Estrogen, testosterone will change your body in some ways that are not reversible, at least not fully. So things like voice changes, body fat redistribution, chest development may not be possible to reverse later down the line. So that's a much bigger discussion that doctors have with adolescents and their families about weighing the risks and benefits. What are the risks of not offering that medication versus what is the likelihood that they're going to start these medications and maybe one day in the future regret some of the physical changes, but what we see from the research is that that regret appears to be very rare.
BROOKE GLADSTONE Could you talk about the steps that trans kids need to go through in order to access puberty blockers and hormones?
JACK TURBAN There are a set of criteria that an adolescent needs to meet and they need to have this diagnosis of gender dysphoria. And that diagnosis requires identifying as a gender different than your sex assigned at birth for at least six months. Many clinics will, on top of that diagnosis, require much more assessment and evaluation before they'll offer any kind of medical interventions. Once kids reach, usually age 16, but in certain clear cases age 14, they might start estrogen or testosterone. General surgery is not offered until adulthood. Often these things are all conflated. You'll hear things like seven year olds having genital surgery or little little kids being given estrogen, but that's not how it works.
BROOKE GLADSTONE Talk to me about de-transitioning. That's when a person who's begun to transition decides to reverse it.
JACK TURBAN So this is another topic that unfortunately has been really politicized. Over and over again, people have highlighted the fact that some people will start gender affirming medical interventions and then stop them, and they've created a lot of panic that that is an argument that we should not offer this medical care to anyone. So we published a study, I think it was last month, a large survey of over 27,000 transgender adults, and we asked them if they had ever de-transitioned at some point in their life. These are people who currently identify as transgender, and something like 13 percent of them said, yes, I've de-transitioned at some point in my life, but over 80 percent of them said the reason they did that was because they couldn't get a job or their family rejected them or their spouse rejected them. There were custody battles and they were afraid they wouldn't be able to continue taking care of their child if they didn't detransition – these external factors. There are a very small number of people who do regret the interventions, but from all the research we have so far, this seems to be on the order of like less than 1 percent.
BROOKE GLADSTONE Let's switch gears for a second to talk about another big political issue right now, this question of trans girls participation in sports. Does the science hold up? Would trans girls have a biological advantage?
JACK TURBAN First, it's important to realize that there's not a lot of research in this area. Most of what people have cited when talking about this is comparing cis gender men to cis gender women. Saying, look, these cisgender men have an advantage, but it's really important to keep in mind that a cisgender man is not a transgender woman. Transgender women may have had pubertal suppression, so they may have never really had much testosterone in their system at all for them to have a theoretical testosterone advantage. They may be on estrogen, which is impacting their capacity to compete. Anyone who works with transgender youth will tell you that, physiology aside, these kids have the deck stacked against them. If you're constantly bullied, if you are reading in the news that your identity is not valid, that you're not safe to be in bathrooms. Probably going to be anxious, you might suffer from depression, and all of those things are going to make it really hard to train and succeed in athletics. I don't think it's a coincidence that we don't see a lot of transgender female sports stars in schools. In California, I think its since 2013 we've had a law on the books that protects the rights of transgender girls to compete in sports leagues that match their gender identity. And we don't have transgender girls dominating sports leagues.
BROOKE GLADSTONE You're a medical professional, you're a scientist, and yet you say that certain questions when it comes to trans identity do more harm than good, like research into what determines transgender identity. What's the harm?
JACK TURBAN There's this long history of trying to understand what makes someone transgender, and the research has led down some kind of awful bizarre paths. There was one theory that maybe transgender girls are actually birth assigned boys who are just very, very cute. People treat them as more feminine and that makes them identify as transgender. Researchers did this study where they took pictures of seven year olds who had at the time they used the diagnosis, gender identity disorder, but they were maybe transgender girls, who took pictures of those kids and took pictures of cisgender boys and showed the pictures to a bunch of college students and asked them, like, how cute and handsome and pretty are these kids? Like, a really disturbing question to ask college students about seven year olds. And they found, I think, like on average. College students were slightly more likely to say these boys were pretty or cute like, AHA! Maybe we figured out what makes someone transgender. They've also done all of these studies to see if maybe it's the mom's fault.
BROOKE GLADSTONE It's always the mom's fault.
JACK TURBAN Psychiatry is a long history of saying it's the mom's fault, and so they did these studies and kind of suggested that moms of transgender kids are more depressed or more interpersonally sensitive. And, oh they must be bad moms, and that's how these children become transgender. I mean they kind of downplayed the other possibility is that if you are a mom with a transgender child, where society's rejecting your child, you might be more interpersonally sensitive with people around you.
BROOKE GLADSTONE Yeah, there was another study that said if the parents hadn't been so lenient, if they'd taken that Barbie away from their son, they could have prevented all of this. They needed to just crack down.
JACK TURBAN Yeah. And as recently as 2002, there was a paper published that was a protocol for conversion therapy. They recommended things like if the birth assigned boy identifies as female to not let that child play with other girls. You know, take them out of sports that they like, force them into sports they don't like, try and force them to identify as cisgender. And we published a paper in JAMA Pediatrics last year that found that people who are exposed to those conversion efforts were more likely to attempt suicide. It's illegal in many states, but a lot of social conservatives are trying to challenge that. To bring back this intervention that we know hurts kids in every major medical organization is that it's dangerous, but these politicians are pushing them forward anyway.
BROOKE GLADSTONE I don't know if you have this kind of data at your fingertips, but what is the risk of suicide? What is the risk of addiction? What is the risk of, I don't know, a miserable life?
JACK TURBAN It's high. Before we had these medical interventions, transgender adults who grew up during these times where they couldn't be affirmed had a suicide attempt rates as high as 40 percent,
BROOKE GLADSTONE 40 percent!
JACK TURBAN 40 percent, at some point in their lives. It gets a little bit tricky because there are two things contributing to their mental health problems. One is their bodies developing in ways that don't match their gender identity. And study after study shows that when you give medical interventions that help their bodies align with their identities, they have lower rates of anxiety, depression, suicidality. However, it doesn't fix everything. Even after those affirming interventions, they still have higher rates of anxiety, depression and thoughts of suicide than cisgender people. And that gets used politically. People will say, look, they had surgery, but they're still more depressed than cisgender people, and that's true. The reason is you fixed one problem, but you also have to fix the way society treats transgender people. What's really insidious is the more you're exposed to those external factors, you start to believe that you are less than for being transgender and then that drives the depression. I'm seeing this with patients all the time. They're starting to internalize what's being said by these conservative politicians and hating themselves. It's hard to watch as a therapist because it's not easy to undo.
BROOKE GLADSTONE Is there something you should have asked you, a misapprehension that you encounter a lot that you'd love to address?
JACK TURBAN Yeah, this is another thing that I think people get hung up on. Being transgender is not the same for all kids. Some kids will be transgender and want medical interventions. There are a lot of other kids who identify as transgender and are fine with their bodies and don't want any medical interventions. For instance, I've had patients who are birth assigned females who just really hate the way society thinks about women, and so they identify as non binary and maybe use they/them pronouns, but are very clear that they're fine with their bodies. And this is more a reaction to societal expectations based on their gender than it is about body dysphoria. And so they don't want medical interventions. But there's this idea those kids are somehow tricked into thinking that they want medical interventions. And, you know, sometimes kids aren't sure what they want and they want to be working with a therapist to figure out what gender means to them. So I was a cisgender boy, I grew up in Pittsburgh and a community that wasn't accepting of gay people, you know, actually heard from my father all the time that gay people should be killed. And it's a sin,
BROOKE GLADSTONE oh, my God.
JACK TURBAN Like, I had a Polly Pocket. I liked a lot of feminine things. And I certainly had the occasional passing thought of, you know, it would be so much easier if I were a girl because, you know, girls are allowed to like boys, but I did not identify as a girl for six months and meet diagnostic criteria for gender dysphoria and insist that I was a girl. And I think that's a very different thing, especially when it goes all the way into puberty and kids start having a really negative reaction to the way their body is developing. And we need to protect their right to access the medical care that they need.
BROOKE GLADSTONE Thank you so much.
JACK TURBAN Of course.
BROOKE GLADSTONE Dr. Jack Turban is a fellow in child and adolescent psychiatry at Stanford University School of Medicine.
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