The Fight in Texas Over Trans Youth

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Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning, everyone. On today's show, our guests will include Questlove. You know him from the Roots, you know him from The Tonight Show, maybe you know him from other things he's done. Well, now he's up for an Oscar for best feature-length documentary for his film Summer of Soul. Questlove coming up later in this program. Also the case for charging Vladimir Putin with war crimes and whether that could deter him in any way from more atrocities in Ukraine. We have David Scheffer on that who has actually been US Ambassador-at-Large for War Crimes Issues. Did you know we had one of those? That's coming up.

We start the show today by looking at the state of anti-trans and anti-gay legislation sweeping some Republican-controlled states. If you don't know about this because you live in the relatively safe from this Northeast, here's some of what's been going on. The Florida Senate voted last week to pass with some of [unintelligible 00:01:11], the "Don't Say Gay" bill. Legislation that bans the discussion of sexuality and gender identity in schools for young children. The free speech organization PEN America says there are at least 15 similar bills in 9 states intended to restrict talk of gender orientation in schools across the country.

Another one. Last week the Idaho House of Representatives passed legislation to make it a crime, a crime, for parents to seek gender-affirming health care for their transgender child, punishable by - ready for this? - life in prison. That bill goes even further by making it a crime for parents to seek health care in another state. Alabama Senate passed a similar bill making it a felony for medical professionals - we're going to talk to a medical professional in just a minute - to treat minors with gender-affirming care, as it's known. Arizona also passed a ban on treatment in the past month, so Alabama and Arizona on that.

All in all, the ACLU estimates there are nearly 30 proposals around the country in various legislative stages aimed at preventing transgender kids from seeking hormone therapy or puberty blockers. As you may have heard on Friday, trans rights advocates won at least one small victory when a Texas judge temporarily blocked one of these laws. Maybe you've heard of this one by now, it's Republican Governor Greg Abbott's directive, which ordered state officials to investigate parents who seek gender-affirming care for their children, investigate those parents as "child abusers." A judge called that policy unconstitutional, and an injunction will stay in place until July when the case is heard fully in court.

With us now to talk through that ruling and more are Chase Strangio, deputy director for trans justice with the ACLU's LGBTQ & HIV Project, and Dr. Jack Turban, chief fellow in child and adolescent psychiatry at the Stanford School of Medicine. He recently wrote an opinion piece in The Washington Post called Texas officials are spreading blatant falsehoods about medical care for transgender kids. Chase and Dr. Turban, thank you for coming on. Welcome to WNYC.

Chase: Thank you.

Dr. Turban: Yes, thank you for having us.

Brian Lehrer: Chase, I see you're an attorney in the case known as Doe v. Abbott in Texas, so let's start there. Can you describe that case and what has happened so far, including the ruling last Friday?

Chase: Yes, absolutely. Thank you for the overview, because I think when we talk about any of these things we have to put them in the context of this national strategy wherein opponents of trans people's very existence are moving pieces of legislation and executive actions like we're seeing in Texas across the country. What happened in Texas was you had Attorney General Paxton issue an opinion letter, which is a non-binding document essentially saying that providing medically indicated, doctor-prescribed medication to a child who is an adolescent, actually who is transgender, could be deemed child abuse.

Now, that non-binding opinion letter was escalated by Governor Greg Abbott, who issued a directive to the child welfare agency DFPS to immediately start investigating families where there were reports that a transgender adolescent was receiving health care. That was on February 22nd. I think many advocates hoped that it would just be political posturing leading up to their primary elections which were happening the following week, but unfortunately escalated very quickly. The agency took the directive, implemented it immediately, and started investigating families.

I think it's important to really stop and recognize what this means. It means that parents who are providing health care to their minor children in accordance with medically supported protocols are now at risk of losing custody of those children. Having a child welfare agency come in and investigate the family, cutting off the care to the adolescent who needs it, and also removing them from a loving and supporting home. We at the ACLU along with our partners at Lambda Legal and the ACLU of Texas and law firm Baker Botts immediately put together a lawsuit. We filed in district court in Travis County, which is in Austin, seeking a emergency TRO to put a stop to this.

We were successful on March 2nd, getting the first order blocking some aspects of the directive. Then on March 11, which was Friday, we had a full day evidentiary hearing on whether or not the judge would enjoin, block the directive's implementation statewide. Thankfully, after that testimony, the judge issued an order recognizing that the directives were in and of themselves lawful. They were outside the scope of the governor's authority and the agency's authority and otherwise unconstitutional.

That was a huge relief for families who were living in abject terror across the State of Texas. I will note that Attorney General Paxton did file a notice of appeal within two minutes of us receiving that order, so the case is already being litigated up the appellate courts in Texas.

Brian Lehrer: Just on the legal front-- and we'll talk about the medical front, the identity front, and things like that as we go, and also with Dr. Turban. On the legal front, conservatives so often make the case that what happens to a child should be in the control of parents, not in the control of, let's say, the public schools if they don't want the children being taught about LGBTQ sexuality or whatever the thing is. It's so much in conservative politics about parental rights with respect to their children.

Is there a legal argument that points to this contradiction? That points to a kind of hypocrisy that says, "Hey, you've been arguing in court and various kinds and in state legislatures of various kinds for parental rights over what happens to their children. In this case, you're trying to take away parental rights?"

Chase: It's important to point out that right now one of the most dominant policy discourses within the Republican Party is this notion of parental rights as it pertains to masks and schools, as it pertains to curricula. Obviously, there is hypocrisy here because what is a greater intrusion upon the parental rights than disrupting the ability of a parent to direct the medical care of their child, and then have that be threatened with losing custody of a child now.

The hypocrisy is glaring. Certainly, one of the key constitutional arguments being raised in this case and in other cases where we're challenging these restrictions is that it infringes upon the rights of parents, which is one of the oldest fundamental rights recognized by our courts, to direct the care, custody, and control of their minor children. That argument is present throughout the lawsuit, both as an affirmative argument on behalf of the individual parents who we're representing, but then also as part of our argument that the agency itself did not have the authority to do this and it's counter to their mandate.

Part of their mandate is to support the parental rights and autonomy of parents to support and raise their children. The hypocrisy is very much on display in every aspect, and the legal arguments present are being presented in court. Did you also focus on the fact that this is such an unbelievably unjustified intrusion into the rights of parents?

Brian Lehrer: All right. Again listeners, if you're just joining us, our other guest is Dr. Jack Turban, chief fellow in child and adolescent psychiatry at Stanford School of Medicine, and author of the opinion piece in The Washington Post recently called Texas officials are spreading blatant falsehoods about medical care for transgender kids.

Dr. Turban, I mentioned some terms in the introduction that many of our listeners may not be familiar with, such as gender-affirming health care and hormone therapy or puberty blockers. Can you describe, first of all in your practice, what sorts of cases along these lines you see, and maybe talk about what those basic terms that always come up in these conversations mean?

Dr. Turban: Yes. Thank you for framing it that way also, because I think one thing that's been really difficult watching the political rhetoric in this area is that people conflate the way that we support transgender kids at different stages of development. If you hear some political pundits talk about these things, they'll make it sound like very young children are having surgery or hormones. That's really not the way that doctors support these kids. I can walk you through, for these cases, the different stages of development.

For pre-pubertal kids, these young kids, there are no medical interventions considered at all. Really, most of the work that we do is working with families, working with schools, working with communities just to make sure that these kids are loved and accepted, and not facing things like bullying, harassment, and discrimination. We also let these kids explore their gender freely. If they want to take on a new name or new pronouns, haircut, clothing, et cetera, we let them do that and just make sure that they're doing it in a space that's going to be warm and accepting, and not harassing or rejecting.

What the research shows is that when you don't let kids explore their gender expression in that way, that's the names and pronouns, we often see worse mental health outcomes because really what happens is you're instilling shame for who they are. That'll damage relationships between the child and the parent and the child and the therapist. Over time, we've learned that really just letting kids explore their gender identity freely when they're at that young age results in better mental health outcomes.

The very first medical intervention that might be considered is this medication you may have heard of called a puberty blocker. These are medications that were first used in the 1970s for kids who have a condition called precocious puberty, just when you start puberty at a very young age that's too early, and it can either be a shot or a small implant that goes in the arm. The nice thing about these medications is that they're reversible. If you stop the shots or you remove the implant the child will go through their endogenous puberty, the period that they would've gone through without the medication.

For these kids who are entering puberty and are transgender and having really negative reactions to the way their bodies are developing, these can be really, really helpful medications. We see kids who are so dysphoric towards their chest developing that they're binding their chest, they might be having breathing problems. Kids often have mental health crises. They may be in and out of the emergency room because of the way their bodies are developing. The thing about your endogenous puberty is that it's really hard for us to reverse that down the line, if not impossible. With things like voice changes, breast development, et cetera, it can be impossible or require surgery [crosstalk].

Brian Lehrer: Just so our listeners are following along, so far you're talking about an older conventional - if that's the right word - use of puberty blockers for kids who are going into puberty at unusually young ages. To help stave that off and prevent the psychological injuries from being very young and girls developing breasts, you were just giving that example that are large or whatever. That's the traditional use of puberty blockers. When does it get used in the case of gender identity?

Dr. Turban: Exactly. I bring up these cases of precocious puberty just to highlight that these medications have been around for a long time; since the 1970s. We've also been using them for transgender youth for at least 20 years. Whenever a transgender adolescent is entering the early stages of puberty, sometimes they'll have a very negative reaction to the way their body is developing, and that's when we might consider this reversible puberty blocker. You can think that's maybe around age 12 or so. Later in adolescence, so as teens are older, that's when we might consider starting medication like estrogen or testosterone, and that really induces a puberty that matches their gender identity.

Research consistently shows that when we take that approach these kids have better mental health outcomes, so lower odds of suicidality, anxiety, depression. As much as Texas would have you believe that these are controversial medical interventions, the research has so consistently shown that they result in better mental health outcomes. That every major medical organization endorses these protocols, so the American Medical Association, the American Psychiatric Association, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, et cetera.

The final thing I'll note is that genital surgery is often used as this inflammatory notion that young people are having these irreversible surgeries, but that's not the case under current medical guidelines. The guidelines that are generally followed are the Endocrine Society guidelines or the World Professional Association for Transgender Health Standards of Car. Both of those highlight that genital surgery isn't considered until adulthood.

The only surgery that might be considered is that for transmasculine people. If they're having severe chest dysphoria, then they might have a long series of conversations with their family and their doctors about the risks and benefits of potentially having a surgery to remove chest tissue. That's the only surgery that's considered for minors.

Brian Lehrer: Chase, before we open up the phones and invite listeners in with their stories of being parents of trans kids or being trans individuals themselves or just people with questions, do you want to add anything to the general category of gender-affirming health care besides the specific treatments and when they're appropriate that Dr. Turban was just describing?

Chase: I appreciate Dr. Turban's thorough analysis. The key takeaway is that these are medications that are used for other conditions and are not prohibited, and certainly not considered child abuse. That they're effective, that they're safe, and that for many people, including myself and many of the trans advocates who are doing this work, they saved our lives. We have a very specific understanding of what it means to have access to this treatment and how it allows you to thrive into adulthood.

What's so terrifying is the prospect that it's going to be taken away from a whole generation of young people who are just at the point of coming to understand who they are and having access to support and systems of care, and we're taking that away. I think the other thing to keep in mind is that this is just an absolutely anomalous intrusion into the medical profession in ways that could have consequences outside of this context. To have the state come in when you have the patient, the parents, and the whole medical establishment supporting a treatment and the state criminalizing it, in the case of some of these bills.

It certainly wouldn't surprise me if it stopped here. I think the implications for what this means for medicine, for pediatrics, and for all of us, are going to continue to be felt.

Brian Lehrer: Dr. Turban, I think one of the main arguments in the Texas attorney general's opinion filed in the court case was that the drugs you were describing constitute child abuse because they can induce what they call transient or permanent infertility. How big a risk is that in your medical opinion?

Dr. Turban: That's just not true at all. It was difficult to read that opinion. It just contains so many pieces that aren't true. Puberty blockers, like I mentioned, have been used for precocious puberty since the 1970s. We have these follow-up studies that show that fertility is actually not impacted at all. Puberty blockers do not cause infertility or-- I think the term they use is sterility. There is a bigger discussion when a young person goes directly from puberty blockers on to estrogen or testosterone because there's a theoretical risk that that may impair fertility.

For those kids, we do have extensive discussions about fertility preservation, so sometimes those kids will preserve sperm will preserve the eggs. That is one of the key parts of this protocol. That if any of these kids are undergoing interventions where there's even a risk of losing their fertility, that we do fertility counseling around preservation. Puberty blockers, which are the interventions that are used for these young adolescents, do not impair fertility.

Brian Lehrer: All right. Listeners, do we have any trans listeners in the audience or parents of transgender kids or adults? 212-433-WNYC. How are you doing in these past weeks and months hearing about these bills in many state legislatures that would basically delegitimize healthcare for trans-minors? We're going to get to the "Don't Say Gay" bill in Florida and things like that, which is another category but, of course, related.

Well, what do you want to say, listeners, about your own early transition or your child's early transition? 212-433-WNYC, 212-433-9692. Did it involve medical intervention like hormone therapy or puberty blockers, and what did those treatments offer you if you or your offspring did use them? 212-433-9692.

Parents in particular, because the Texas directive would have held parents liable for child abuse for gender-affirming medical care, parents of transgender kids, what do you want to say about seeking gender-affirming medical care of any kind for your child? What did that process entail and what are you thinking when you hear this framing of child abuse? 212-433-WNYC, 212-433-9692.

Or anybody outside of those experiences who have questions, also welcome as we talk to Chase Strangio, deputy director for trans justice with the ACLU, their LGBTQ & HIV Project. He was involved in the Texas case up to this point with the ruling that came down on Friday night that at least for the moment suspends the state's right to investigate parents for child abuse for these kinds of gender-affirming health care practices as they're called. Our other guest, Dr. Jack Turban, chief fellow in child and adolescent psychiatry at the Stanford School of Medicine.

Well, I'll tell you what? Why don't we take a break right here and then we'll continue? I want to give you a bigger picture pushback that was in the Texas attorney general's opinion that involves the percentage of kids who transition, who then later in adulthood transition back, and what that says about when it's proper to do what. Our phones are full. Our phone lines are full right away after giving out the number, so we'll hear from some of our listeners. Stay with us. Brian Lehrer on WNYC.

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Brian Lehrer on WNYC as we continue to talk about the raft of legislation, mostly in Republican-controlled state legislatures around the country. Anti-LGBTQ legislation of various types like the "Don't Say Gay" bill in Florida, which we will get to. Also, anti-trans affirming health care legislation like the case in Texas where they would investigate parents of trans children who receive certain kinds of care for those kids as child abusers. You know who our guests are because we've told you just before the break and a number of times so far. Our lines are full with people with stories and with questions, so let's hear from some of you. Amy in Brooklyn, you're on WNYC. Hi, Amy.

Amy: Hi. I'm calling because I have a 10-year-old daughter who told us she was trans pretty much as soon as she could talk at two. As soon as she was old enough to understand, she's always known that one day she could have surgery and she could have the hormone therapy and have the body that she should have had as a woman. That has meant everything to her. I mean, that's like her lifeline, and I just can't imagine her going through life not being able to have that.

Brian Lehrer: How did you hear it when she was as young as two in a way that was clear to you, or how did it develop a little bit over time from that point where it was clear to you what was clear to her?

Amy: Even before that, she was always wrapping her blanket around herself like a dress. What happened was she said, "When I grow up I want to be a builder." My son, who was three and a half, said, "Well, girls can't be builders." He thought she was a girl. I said yes, they can. Then my husband said, "Well, Noah, you're not a girl, you're a boy," and she said, "No, I'm a girl."

Brian Lehrer: Ten years old now, what kinds of medical interventions, if any, have you considered or would you consider at a certain point if you've looked into it?

Amy: Well, the medical intervention now is we take her to a clinic where they just test to see if she's going to go into puberty anytime. She'll do that for a few years, and once she's at the right point of going into puberty then we'll do the pure puberty blockers. Then when we think it's right and when society thinks it's right or doctors or the trans parent community, we'll switch to hormone therapy to have her have female puberty and then the surgery when she's over 18.

Brian Lehrer: Amy, thank you for your call. Thank you for your candor about your daughter and yourself. I appreciate it. Vlad in Manhattan, you're on WNYC. Hello, Vlad.

Vlad: Hello. Thank you so much for having me. I'm trans. I'm going to keep it short. I started transitioning when I was 23, so this year in January. Personally for me, it's something that has always been on my mind. I always knew I was somewhat trans, especially when I found out about it when I was 12, but before that I always felt like I wasn't in the right body, I wasn't in the right space.

I'm glad I got the space to be a woman before I was able to start transitioning to be a man. I'm female to male. For me it's good, but I do know that hormone blockers is a big topic of conversation because people don't know if this is the right thing for their child or whatnot. I do think that hormone blockers give the children who may have questions about their gender just more space to live through it before they start transitioning into any space.

The question of detransitioners, actually I was looking into these transitioners as I was deciding if I wanted to transition or not because I always was raised in a space where trans is not something that I could even have a right to, but I saw other people do it. For me detransitioners, it was something great to learn about as I transition because I was learning about why people went back to a certain place that they were born into and why they wanted to transition back into the gender role they were born into.

It also made me feel less worried about me moving into being a man and transitioning because of the fact that I saw and understood truly through YouTube why people detransition and how I felt. That was very far from what I felt. I think hormone blockers allow young people-- I don't know how young. I'm not a doctor to say how young people should go on hormone blockers or any therapy, but I can only say that hormone blockers give you the space and your child the space, for concerned parents like Amy who spoke before me, about just to consider the space they're going into and really look into that.

Brian Lehrer: Vlad, thank you very much. I appreciate you sharing your experiences at age 23 and looking back just a little bit. Again, our guests are Dr. Jack Turban, chief fellow in child and adolescent psychiatry at the Stanford School of Medicine, who also wrote an opinion piece in The Washington Post called Texas officials are spreading blatant falsehoods about medical care for transgender kids, and Chase Strangio, deputy director for trans justice with the ACLU's LGBTQ & HIV Project. A litigant in the Texas case to prevent parents from being investigated by the state for child abuse.

Chase and Dr. Turban, some pushback. The Texas attorney general wrote in their opinion, "There is no evidence that long-term mental health outcomes are improved or that rates of suicide are reduced by hormonal or surgical intervention." That "Childhood-onset gender dysphoria," and we'll talk about that term, "has been shown to have a high rate of natural resolution, with 61% to 98% of children reidentifying with their biological sex during puberty." Dr. Turban, do you want to take that maybe in two parts?

What's the evidence that medical treatment helps improve mental health in the long term, because that's one of the arguments. As people who are trans but are not being treated as trans suffer all kinds of mental health consequences, suicide rates are higher, et cetera. Take that, and the terms gender dysphoria and detransition or, I guess, transitioning back. The last caller used that.

Dr. Turban: I guess the first thing we can look at is Paxton's assertion that there aren't long-term follow-up studies for these medical interventions.

Brian Lehrer: That's the Texas attorney general, Ken Paxton.

Dr. Turban: That, again, is not true. For instance, we published a study where we looked at transgender adults and we asked them "Have you ever accessed gender-affirming hormones and at what age did you access them?" There were hundreds of people who accessed them as adolescents and then we measured their metropolitan adulthood. We saw that those who were able to access these medical interventions had lower odds of suicidality and severe psychological distress when compared to people who wanted to access these interventions but weren't able to.

Similarly, there have been longitudinal studies that have followed kids from when they were very young receiving puberty blockers, checked in with them again when they were receiving gender-affirming hormones like estrogen or testosterone, and then saw them again as adults after they'd had gender-affirming surgery. Their mental health steadily improved over the course of that protocol.

That there are long-term studies into adulthood looking at these different interventions and their impact on mental health. Over and over again we see that mental health is improved over the course of this medical protocol.

The second point was a creative one that they made in that opinion when they claimed that the vast majority of these kids are going to identify as cisgender later in life. The studies that they're citing are old studies of kids who are very young. These pre-pubertal kids who, again, don't receive any medical interventions under current protocols and they were kids who were referred to gender clinics. If you look at the studies, most of them actually probably weren't transgender and they didn't meet criteria for-- the diagnosis at the time was called gender identity disorder.

They were probably just cisgender boys who had some feminine interests. Maybe young boys who liked dolls or liked playing with dresses and their parents panicked and brought them to clinics for gender, but then when they followed up with these kids later in life they weren't transgender. Really that's not surprising because they likely weren't transgender to begin with, so you wouldn't expect them to be transgender at follow-up. That being said, the broad clinical experience of doctors all around the world really is that once a transgender child reaches these early stages of puberty, which is the first time that we start to consider medical interventions, it's very rare for them to later identify as cisgender.

There have been large studies of hundreds of kids or 97% or more of them. Once they reach that stage of early puberty and are starting a puberty blocker, they continue to identify as trans and generally stay on these medications. The few who stop the medications, like you were mentioning this concept of detransition, I think people often conceptualize that as people started these medications and then they stop them and they always regret having done that if they stop them.

In reality that's not what we see. Puberty blockers in particular, like one of the callers mentioned, they really just prevent the progression of puberty to give these kids more time to understand themselves. Again, the vast majority of these kids are going to continue to identify as trans. In the rare instance that maybe they identify as non-binary or the even rare instance where they do identify as cisgender, ultimately they can just stop the puberty blocker and then they're going to go through the puberty they would've gone through otherwise.

Whereas for those 97% of kids, if they didn't get the puberty blocker their puberty is irreversible. Puberty blockers we can reverse, puberty itself we cannot. As those kids develop breast tissue their voice deepens, et cetera, their mental health is getting worse and worse and it's really hard for us to undo that later. Overall it's just not true that the vast majority of kids who start these medical interventions are going to stop them. The vast majority are not. Again 97% plus.

Even for those who do, it's much more complicated than they just wake up one day and regret them. It's usually something like their identity is evolved as something more non-binary and they've decided "You know, I don't need these medications anymore," but that doesn't necessarily mean that they regret them.

Brian Lehrer: Leonore in Manhattan, you're on WNYC. Hello. Leonore, are you there?

Leonore: Oh, hi. I just want to dispute some of these claims. There is no test for what a transgender child is. The idea that there's a true kind of transgender child and then one that changes, this is all retrospective. A lot of the research is correlational, it's not causative. The thing that hasn't been mentioned at all really, I think, is the social context and the fact that this is this gender dysphoria. Contemporary gender dysphoria is often associated with other mental health problems like autism for example.

That the detransitioners, who are actually numerous now and are forming organizations and self-help groups-- There was a thing on Sunday called Detrans Awareness Day, and there was-- I don't know. There were lectures and webinars and they're posted online. These are individuals who feel that they were mistreated by the contemporary "affirmation approach." That they should have had a more exploratory approach. That they were taken in by the YouTube influencers. That they were swept up in a kind of self-identification mania, and that they actually had a mental condition. Now, I will say that I was the co-director of a sex and gender clinic at Montefiore Medical Center in the '90s.

Brian Lehrer: Are you Leonore Tiefer?

Leonore: Yes. I'll just stop at that point. I come from the older model that is not the gender-affirming model.

Brian Lehrer: Can I ask from your-- and I know that you've done a lot of work in this field, I've read some of your work. You're a feminist scholar for many years. Even if you dispute psychologically what's going on with some of these kids, maybe even some of these adults, do you stand with the trans community in saying it's outrageous that the State of Texas or any other state would investigate parents for child abuse if they explore gender-affirming health care, as they call it, for their teenagers?

Leonore: What's going on in Texas is not on planet Earth with regard to anything. Why should it be on planet Earth with regard to this? I think the abuse of the right-wing or the use by the right-wing of these kinds of arguments has to be separated from what's really going on in this psychological area. The right-wing, what do they claim about vaccines? What do they claim about this, that, and the other? That's a separate matter. Yes of course it's outrageous, but the gender-affirming model that has captured approval at the present time is not as sturdy as your guests would claim. The research is weak and there are new organizations.

I really think that this is a transgender political movement for civil rights that has somehow infiltrated a lot of professional organizations that have been intimidated from coming forward with their alternate--

Brian Lehrer: Few points. All right, Leonore. I'm going to leave it there. Chase, can I throw that to you as an ACLU trans rights lawyer because she put this in the political realm? Then I'll ask Dr. Turban for a medical psychiatric response as well because she's saying that these are really cases of mental illness in many cases that are being treated as the, what she thinks, much fewer in real life actual cases of people being born into the "wrong bodies."

Chase: I want to respond to a few things. I think first, it's absolutely impossible to separate the political context in which states are criminalizing this care from anything else. The idea that there's some powerful transgender movement that's infiltrated anything, I think is completely belied by the reality that we have 35 states in this country trying to ban health care for transgender adolescents. You have trans youth being pushed out of schools. You have rates of suicidality close to 50%.

We're talking about a community that is under both systematic and individually perpetrated assault, such that it would be impossible to credit the idea that somehow we're all simultaneously so powerful that we can influence the clinical paradigms of every major medical association in the United States. I think that that's just simply impossible to credit. The reality of what is happening is that states are taking away survival opportunities for these young people. If we're not talking about that, there won't be a population to even clinically investigate to identify best practices. I think too this idea that there is some sort of pressure to be transgender that is influencing the numbers of people that we're seeing now and that YouTube is to blame, obviously this is the type of rhetoric that we hear in other contexts as well. When we look at history and society, obviously the pressure is not to be transgender, it's to be cisgender.

Most of us who are trans have gone through deep personal struggles and quite a lot of pain both internally with our families, with our communities. The idea that there's some pathway that we're being pressured into this is counterfactual given the structural imperatives in society to be heterosexual and cisgender. I think that too is just simply difficult to credit in any real way. The fact that there's changing demographics or the fact that more people are feeling more comfortable coming out is a product of the ways in which society is thankfully changing, but it is disheartening to see that it is through people's embrace of who they are that there are movements to suppress and in some cases eradicate us.

The idea that there's a so-called powerful movement of people who are detransitioning is inaccurate. Many people, as Dr. Turban mentioned, may have varying experiences with treatment over time, but the idea that there's this political movement to stop health care among those who have detransitioned is a small subset of people who have been taken over by a very powerful right-wing lobby machine that has global reach and very, very significant funding streams.

Those are some of the key points I want to make. I know that Dr. Turban can dispute some of the misinformation from the caller about the comorbidities related to autism and other diagnoses.

Brian Lehrer: We only have two minutes left in the segment. Listeners, we're going to have to take up the "Don't Say Gay" bill in Florida in a separate segment because we've spent the whole time on the question of trans and trans policy questions. Dr. Turban, give a last response here. For you in your practice, how do you determine if a child's - let's say a teenager's because we're talking about adolescents here. Again, that's one of the misnomers that we're talking about like little kids - interest in getting any of these treatments is a function of what the caller described as mental illness as opposed to really being a trans individual?

Dr. Turban: I'll try to speak quickly. [chuckles] I do respectfully disagree with the framing here. There are higher rates of mental health problems among transgender and gender-diverse teens. While we consistently see the high rates of things like anxiety and depression, the research about things like autism is much more contested. If you think about it it's not particularly surprising that there are high rates of anxiety and depression for these kids. 80% of them are bullied. We're seeing that they're being attacked on a national scale by these very powerful politicians.

They're saying things like, "You're a risk to people in bathrooms. You're a danger to your peers and sports teams. You're actually just mentally ill. You don't really know who you are." Of course, when you sit with these kids, even if they know those things aren't true on a conscious level, it's hard for those things not to seep in on an unconscious level, and that drives those high rates of anxiety and depression.

On the flip side, we have all this research that shows that when parents accept these kids and their peers accept them, when they receive the gender-affirming medical interventions, that their mental health dramatically improved. In some instances where they are allowed to truly just be who they are from a young age, they don't have higher rates of mental health problems. Kristina Olson's work at Princeton has found that when kids are supported in their transgender identity from a young age, their mental health is actually not particularly different from their siblings or from cisgender controls in the community.

Of course, there are kids that have more complicated mental health concerns. Kids with autism, kids with bipolar disorder, schizophrenia, et cetera, who may also be questioning their gender, but it's just not true that we would immediately start this group on hormones. They would have to identify as transgender for at least six months to meet the criteria for gender dysphoria, which is a prerequisite for any medical intervention.

Of course, for any of those kids where things are more complicated, we really take our time. That's why they work with psychologists, psychiatrists, their families, and their doctors to really make sure that they're making the best-informed decision for them, but that needs to be a decision between families and doctors and not just driven by politicians.

Brian Lehrer: Dr. Jack Turban, chief fellow in child and adolescent psychiatry at Stanford University School of Medicine, and Chase Strangio, deputy director for trans justice with the ACLU’s LGBTQ & HIV Project. Thank you both so much for joining us this morning and giving us so much time.

Chase: Thank you very much.

Dr. Turban: Thank you for covering this.

Brian Lehrer: Brian Lehrer on WNYC. Coming up next, the case for charging Vladimir Putin with a war crime and whether that could deter future atrocities in Ukraine, and then Questlove will come on the show. He's actually up for an Oscar for a documentary that he made last year. Stay with us.

 

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