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Our conversation about anti-trans laws is broken

Let’s stop pretending that bills denying trans kids health care are something other than bigotry that will get children killed.

Protesters in Alabama oppose bills targeting transgender youth that were introduced in that state’s legislature in March.
Julie Bennett/Getty Images
Emily St. James was a senior correspondent for Vox, covering American identities. Before she joined Vox in 2014, she was the first TV editor of the A.V. Club.

A lot of people do not care if trans people die.

Many of them are Republicans, passing laws in state legislatures that treat our lives as abstractions played out in vague hypotheticals. South Dakota’s Republican governor signed two executive orders banning trans kids from high school and collegiate sports. Even more horrifying, Arkansas’s Republican-dominated legislature passed a bill banning necessary trans health care for kids. And those are just the most recent examples of anti-trans legislation. Several others have already become law, and still more bills are winding their way through the legislature in many other states. (Alabama and Tennessee are also considering banning trans health care for kids.)

Others who don’t particularly care about trans lives include many right-wing pundits, smugly making easy, hacky jokes about trans women looking like big, scary men in dresses.

And at least some of the people who don’t care about our lives are in the media, covering issues that affect trans people without talking to actual trans people — or failing to recognize the stale arguments coughed up against us by astroturfed conservative advocacy groups as warmed over from the days when similar arguments were made about gay men and lesbians.

But none of them fundamentally care if trans people die.

I am aware of how dramatic this sounds. I cannot see into the hearts of every single one of these people to determine the precise degree of their transphobia (though at least some of them don’t make any effort to hide it). I am sure that if I asked them if they care about trans people dying, they would say something like, “Of course I do.” And yet they’re perfectly content to treat our existence as a ripe topic for debate.

So let me be blunt: The current wave of anti-trans legislation sweeping various state legislatures is an attempt to ostracize trans Americans. It is an attempt to cut off our access to necessary health care. It is an attempt to kill us through the indifferent cruelty of bureaucratic measures.

Most media attention has been focused on bills attempting to ban trans kids from playing high school sports, which has been covered effectively elsewhere. My quick rebuttal: Even if we were to grant anti-trans forces their position on high school sports — the shortsighted belief that “boys” will unfairly compete on girls’ teams, where they’ll naturally dominate — it’s not clear why anyone would jump through all the hurdles of transition just to play on a high school girls’ basketball team. It fails the common sense test.

I’m far more concerned about even more odious bills winding their way through various legislative bodies, designed to strip hormone treatment from trans teenagers. These bills will effectively force trans teens through a puberty that will cause them immense emotional and psychological harm. Some of these teens have been living as themselves for much of their childhood, without most people in their lives even knowing they are trans. But without access to puberty blockers and hormone treatments, trans girls will develop facial hair and deep voices; trans boys will grow breasts.

Numerous studies have shown that trans teenagers are more at risk of death by suicide than their cisgender peers. A 2018 study by the American Academy of Pediatrics found that trans boys showed a 50.8 percent rate of attempted suicide (compared to 9.8 percent for cis boys), while trans girls showed a 29.9 percent rate (compared to 17.6 percent for cis girls). Nonbinary teens reported a 41.8 percent rate and gender-questioning teens a 27.9 percent rate.

But when trans children receive gender-affirming health care and the support of family and peers, their risk of death by suicide declines substantially. (I don’t like to talk about it, but I spent most of my life consumed by suicidal thoughts until I began transition.) What’s more, trans children who are affirmed in their gender have less risk of anxiety and depression than trans kids who are not, and a 2014 study of trans youth showed that allowing them to transition as children led to positive outcomes.

There is a reason every major American medical body recommends giving trans children the chance to transition. (Here’s an article from the American Medical Association’s Journal of Ethics making this argument 11 years ago.) Children first transition socially — with changes to their clothing, haircut, and name. Then, with a physician’s guidance, they can block the onset of puberty in early adolescence, and finally start hormone treatment in later adolescence.

This method works. We have records of trans children receiving hormone treatment as long ago as the 1930s. With this approach, trans kids can largely live lives that are indistinguishable from those of cis kids. (If you don’t believe me, consider the surprisingly large number of famous trans women who transitioned as kids, like Nicole Maines, Kim Petras, and Hunter Schafer.)

The concept of “passing” — a binary trans person being read as their gender, rather than as the gender they were assigned at birth — is a fraught one in trans circles, because it is too easy to use as a cudgel against those who seemingly don’t pass. But blocking trans kids’ access to puberty blockers and hormone treatments will indisputably affect their ability to pass, should that be a desired outcome for them. And that, in turn, will increase their risk of encountering transphobia and transphobic violence as adults, particularly if they are Black or brown trans women. In 2020, at least 44 trans women were killed, the substantial majority of whom were Black or brown trans women. That was the highest number on record to date.

In contrast, trans teenagers who receive the right synthetic hormones will have options when it comes to disclosing their transness. I recently met a woman who transitioned as a teenager (in the 2000s, no less), and she is simply assumed to be a cis person within her field. Nobody has ever guessed otherwise. Too many people who don’t receive those hormones will always be “the trans one” in too many rooms.

Trans people are a lot harder to demonize when you can’t tell who we are, when we could just be another girl on the volleyball team or another lead actor in the high school play. Clinging to the harmful stereotype of “scary man in a dress” — which is the stereotype used to prop up so much of this transphobia — all but requires making it logistically impossible for someone to transition until they are well into adulthood. (But also, be nice to someone you think is a man wearing a dress. I’ve been her, and it’s really, really scary.)

The Arkansas bill specifically ties “gender” to reproductive organs. That move effectively defines “womanhood” as an ability to bear children, which is so self-evidently a hop, skip, and jump away from an attack on abortion rights that it should give anyone in support of those rights serious pause.

But even more egregious is the bill’s privileging of reproductive capacity and the idea that a presumed horror awaiting trans children as they grow to adulthood is an inability to have biological children. As an adopted person (who will likely have to adopt children herself for reasons unrelated to my transness), this particular argument waged by anti-trans forces is particularly offensive. It’s also a signal of how American society remains deeply biased in favor of cisgender heterosexuals who pair off and have children, even though we know how many queer people, of all stripes, exist within our world.

The arguments being advanced against trans people are the same ones used against gay and lesbian people, and they’re the same arguments that were used against women in the workforce in the 20th century, and they’re the same arguments that prop up structural racism: There is a certain way America looks, and it’s not like [insert out-group of choice].

These bills and most of the coverage of them are cis-sexist. Much of the opposition to trans people — or even the unstated icky feelings that many cis people have about us — originates in the feelings of cis parents who are trying to halt their trans kids’ transitions or the idea that a trans person might someday regret their transition and wish they could take it back.

It is worth exploring the sadness of cis parents and especially the depth of feeling some detransitioners have. But the humans whose lives will be most affected should be the priority here — and we must not lose sight of the fact that they are real people, not intellectual thought exercises whose existence can be defined through the inconveniences they might cause the status quo. Conversations about the intersection of cis lives with trans lives or about detransition lose all value if they are presented within a specifically cis framework, starting from a foundational belief that transness is an aberration to be avoided at all costs and otherwise pitied. We are not aberrations. Being trans is just another way to be human.

There is a mistaken assumption among many cis Americans (at least the ones I talk to) that “trans people” equal folks like me — relatively affluent white trans women who transitioned as adults, seemingly on a whim, and now won’t stop talking about it. But the majority of trans Americans are working class or come from working-class families. Many of us are not white. Most of us are barely scraping by.

The extremely thin social safety net that bears us up in the United States is, shockingly, one of the better ones for trans people. That’s only because the world is so weighted toward cis people that there are disastrously few places where trans people can find the care we need. That social safety net isn’t just worth preserving; it’s vital, as is creating better access to trans health care for all trans Americans.

But I am a relatively affluent white woman who transitioned as an adult, and I have a media platform, and I’m not going to stop talking about it. Saw away at the social safety net, and trans people — lots of us — will die. It is that simple, and it is worth thinking about whether that blood is worth so many hypotheticals that turn us into imagined monsters rather than people just trying to survive another day in a country that increasingly doesn’t care whether we live.

Those who question the stories of trans people — especially trans youth — rob us of our autonomy to define our lives. They argue, sometimes implicitly and sometimes explicitly, that cis people are the true arbiters of who we are. They suggest that when trans people advocate for our interests, both as individuals and as a community, we are being selfish, naïve, and uncompromising. But it is not selfish to say you have a self, it is not naïve to believe that you know that self better than others, and it is not uncompromising to insist that you should live a life of dignity the same as anybody else.

Every day that cis people guide most of the conversations about trans people is a day that further suggests our lives are not worth living as they are. But if our lives are what we say they are, and if they are not worth living as they are, what are you trying to tell us? Where would you have us go? Answer that question. I’m waiting.