#23: Trans Legislation, Misinformation, and Advocacy
COMMUNITY VOICE: Jace Wilder | HEALTHCARE EXPERTS: Meredithe McNamara, MD; Kellan Baker, PhD
CITING! OUR! SOURCES!
Note: There is MUCH more literature to support the claims made in our episode by the hosts and our guests. This is a sample. If you don’t see something cited here, and want to, please contact us by emailing us or reaching out via the contact form on our website.
For an up to date overview of anti-trans legislation of best practice medical care bans, check out this link to see the current political map.
Dr. McNamara’s peer-reviewed manuscripts we reference. Within these are links to debunk the specific false (!) claims that social contagion, the use of gender identity conversion therapy, and rates of regret (see below for data on “detransition” rates)
“A thematic analysis of disinformation in gender-affirming healthcare bans in the US”, linked here
Bans on Gender-Affirming Healthcare: The Adolescent Medicine Provider's Dilemma, linked here
Protecting Transgender Health and Challenging Science Denialism in Policy, linked here
Scientific Misinformation and Gender Affirming Care: Tools for Providers on the Front Lines, linked here
Combating Scientific Disinformation on Gender-Affirming Care, linked here
Scientific Misinformation Is Criminalizing the Standard of Care for Transgender Youth, linked here
This review of progressional medical organizations showed that “available positions were overwhelmingly supportive of individualized access to gender-affirming therapies in adult and adolescent populations”.
SHOW NOTES
The framework for this episode
Dr. McNamara’s five themes of disinformation around best practice trans medical care. They include false and misleading claims about:
Gender dysphoria and gender identity
Evidence regarding gender affirming care
Standard practice of gender affirming care
Safety of gender affirming care
A rejection of medical authority
Data that gets mis and disinformed around the concept of “detransitioning”
That study that came out of Australia that Dr. McNamara mentions: Cavve et al in JAMA Pediatrics May 2024 (linked here).
They conclude: “A small proportion of patients, and a very small proportion of those who initiated medical gender-affirming treatment, reidentified with their birth-registered sex during the study period.”
99% of folks who received any gender related medication (here puberty suppression or hormone treatment) did not re-identify with their registered birth sex.
Regret following gender affirming surgery…
Was found to be 0.3% of individuals. Linked here. Another survey of satisfaction and regret post gender affirming mastectomy found “The median Decision Regret Scale score was 0.0 (IQR, 0.0-0.0) on a 100-point scale, with lower scores noting lower levels of regret”, linked here
And what regret does exist, albeit very minimal, is much lower than rates of other surgery types for gender affirming surgery, linked here
The TRICARE (a type of military medical insurance) studies Dr. McNamara mentions as being cited out of context to show “detransition”
To stay up to date we recommend the following resources:
First and foremost - Erin in the Morning - a substack with up to date information on changes to legislation for the trans community. On New Year's Day, Erin’s subscribers (paid and unpaid) were sent a summary of good things that happened in 2024 with the following summary of studies and reviews that supports current standards of care for trans youth:
Study shows trans youth are satisfied 6-10 years later with their decision to medically transition, with extremely rare instances of regret.
Study shows anti-trans laws are harmful, directly increase suicide attempts in states that pass them. In states that don’t, no such increase happened.
Australian study shows only 1% of trans people reidentify as cisgender.
New study debunks “Social Contagion” theory of being trans.
Finnish study used to show transgender care doesn’t work accidentally shows trans care saves lives.
Yale Integrity Project debunks Cass Review often cited in trans care bans.
90,000 trans people, largest survey ever, indicate extreme satisfaction with decision to transition.
Systematic review of trans surgeries shows regret is extremely low.
TRANSCRIPT
Jace Wilder: The message is that we're here and that we're not going anywhere, that you can ignore us, you can act like we're not voting, but we are. We are still Tennesseans, whether you like it or not, and we're just not going anywhere. Trans people in Tennessee matter, and not only matter, but are empowered individuals.
[QHP THEME MUSIC BEGINS]
Richard: Welcome to Queer Health Podcast! I'm Richard, and I use he and him pronouns, and I'm a primary care doctor in New York City, I have been practicing LGBTQ health for more than 20 years. And I am fully here for the entire cast of the Wicked movie. Ariana should win the Oscar. Just sayin’.
Sam: Will that be a hot take? Time will tell. I'm Sam. I use he and him pronouns and I was, but am no longer ambivalent about them making two instead of one Wicked movies I am also a primary care doctor in New York.
Gaby: I’m Gaby. And because Sam drafted this part of the script, he wants me to share that I have seen all of Wicked with the original cast because I grew up in New York City, which is where I am also a primary care doctor.
Sam: Oh, you're such a good sport. I love that about you. If you're not listening to the Wicked soundtrack, YOU are currently listening to Queer Health Pod season 3 episode 4 about combating transgender medical care disinformation.
[QHP THEME MUSIC ENDS]
Richard: Today, we're talking about the medical and scientific misinformation and disinformation in order to tackle the issues behind the laws and regulations that prevent trans folks from accessing best practice medical care.
Gaby: Or, putting this another way, we're going to talk about the different kinds of disinformation that are used to promote transphobic and medically unsound legislation.
Sam: If your brain is anything like my spellcheck, it is probably confusing mis and dis information. We would like to differentiate them for the sake of having specific vocabulary to fight against the way both of these are used to limit access to trans care. Misinformation is false or inaccurate information that is spread regardless of someone's intent to deceive. Disinformation is deliberately false information spread with the intent to mislead or deceive.
Gaby: Um, I don't mean to be reductive, but both sound Bad.
Sam: I think they're mis-bad and dis-bad, if that's what you're trying to say, Gaby.
Gaby: Well, what I'm trying to say is that I think it's important to note the difference between these words because we think being nuanced with our definitions helps people who are fighting these kinds of incorrect information, and it helps people advocate for better practices around trans care as a result.
Sam: Yes - and we also think it's helpful when arguing to label when someone just doesn't have the right information such as misinformation or when they're actually trying to mislead or lie to folks – a la disinformation.
Gaby: Yeah, and I think the key there is that – look, there's a lot of malice and mal-intent out there. And then there are also a lot of good people who think that they're looking out for people, and believe that they have really good intentions, and were given incorrect information, and are operating off of that. And so that, to me, is why the duality of these terms is useful, because, well, bad actors are bad actors. And good people with bad information making tough decisions is, like, another problem entirely, and it requires a slightly different approach, to be honest.
Richard: I think it's also really important for us to say at this moment that regardless of whether folks are misinformed or have spread disinformation, we believe that trans people have the right to gender affirming care. We provide and support that for people because of good scientific data that actually supports good outcomes with gender affirming hormone therapy.
Sam: We want to give folks, if not a trigger warning, perhaps a content advisory: that there is a lot of content in this episode that makes us very angry. And we imagine it'll do the same for listeners. We'll be talking about specific bits of dis and misinformation. And much, if not all of it is transphobic.
Gaby: So we're gonna repeat a lot of this disinformation here, but then we're gonna debunk it. So we hope that listening isn't gonna be too much of a bummer, and in fact, our three guests are all really inspiring activists who come at this work from very different professional and personal angles, but particularly at a time like this give me a lot of hope.
[TRANSITION MUSIC]
Richard: Alright, disinformation, legislation, access to medical care for trans individuals. Why are we talking about this today?
Gaby: It's kind of like a niche topic, really not in the scene right now. I don't know.
Sam: The political drumbeat around medical care for trans people, especially those under 18, has been getting louder and louder since the first proposed legal bans on best practice trans medical care, which was around 2019. And those picked up in 2021 when Arkansas became the first state to actually ban gender affirming care for minors. Depending on the punditry that you buy into, in many ways trans medical care for minors and trans health in general has become a new political wedge issue.
Richard: The interviews for this episode were done in the spring of 2024, so before the 2024 election had, shall we say, happened. We'll give some more timely context when needed, but we just want to be clear that the policies and laws that work against having access to best practice transmedical care predate the election of 2024.
Sam: When talking to folks who think trans health care is not data-driven or that it targets vulnerable children – which it does not – it’s challenging to respond with anything but a gut response of " that's not true" or "it isn't obvious!”
Gaby: But our goal today is to actually get folks out of that gut instinct, which I have too. And instead give them a different framework on how they might use either personal or professional expertise to talk up specific arguments. And whether that happens at the family dinner table or at your local legislator's office is really up to you.
Sam: We hope that the table discourse did include Wicked Part 1. Was it a soundstage? Did they do studio vocals? So controversial.
Richard: Ok, yes, Sam, we get it. You have feelings. They're not sudden and they're not new.
[TRANSITION MUSIC STARTS]
Regardless. We want you, the folks who are listening to this right now, to feel that you can break down and combat disinformation in a way that is persuasive, compelling, and most importantly, true to your values and opinions.
[TRANSITION MUSIC ENDS]
Gaby: Before we get into – well, the disinformation – we wanted to give Jace, our community voice, a little bit of time to talk to us about the actual process and the emotional toll of giving a testimony.
Jace Wilder: My name is Jace Wilder. I use he/they pronouns. I am the education manager for Tennessee Equality Project. I have been working against anti trans legislation since I was 18. I first got introduced to it really through, obviously my own experience as a trans person in Tennessee. I was constantly running into it and felt really disempowered by it. especially as a teenager. But once I got to college, I had the freedom to start interacting with some of the people that were having these conversations in the room. And a lot of them, even though they were well intentioned, they were all cisgender individuals that were leading these conversations. And so I felt really inspired to become the person that I needed to see growing up and to get into those rooms whenever I could to speak against anti trans legislation and to also educate those around me about what the actual impacts were for trans community in Tennessee.
Sam: We'll come back to the role of research and policy experts, as well as the medical professionals in legislative testimony. But: all of the folks that we spoke to for this episode emphasized multiple times how testimony about personal experiences for trans individuals is the cornerstone of legislative advocacy. One of those people we did speak to is a national policy expert who we'll introduce here.
Kellan Baker: My name is Kellen Baker. My pronouns are he, him, and I am the executive director of Whitman Walker Institute. The Institute is a research policy and education organization that works to advance health equity nationwide with a particular focus on LGBTQI+ people.
Richard: We asked Dr. Baker to give an overview of trans legislation in the US. This was a recorded, again in spring of 2024 though, this holds true as of this publication in the winter of 2025.
Kellan Baker: I would characterize the current state of the policy landscape around transgender people in general, and access to gender affirming care, honestly, as a hellscape. It's apocalyptic out there in terms of the ideological attacks that so many states are making against trans people, trans young people, their parents, trans people of all ages, trans communities more broadly. There's almost no area of life for trans people that has been left untouched by some of the legislation that has been passed in almost half of the states as of the middle of 2024. So we're talking about bans on best practice medical care, we're talking about bans on participating in sports. There are bans on access to restrooms and other appropriate facilities. There are "don't say gay, don't say trans" laws that are restricting curriculum about LGBTQ issues in schools. There's basically nowhere where a transgender person can go these days in some of these states and be truly safe as who they really are.
Gaby: Again, we are coming to you all in 2025, in the Trump administration, and so we know that things are changing rapidly all around us, but this didn't start just now, and Dr. Baker gave some great context as to how we got into this hellscape in the first place.
Kellan Baker: Over the last couple of years, starting particularly around 2021, it really has been full throttle. We have seen an incredible jump in the number of bills that have been introduced targeting transgender people specifically or targeting the LGBT community more broadly. Typically around 10 percent of bills pass. What we've been seeing over the last couple of years around these attacks on transgender people is that the volume of bills that have been introduced is so huge, hundreds and hundreds of bills targeting transgender people have been introduced in basically every state. At this point for instance, bans on best practice medical care for transgender people have passed in 24 states. But even if only 10 percent of them get through, that's still a lot when you have this tidal wave of hate that has been directed at LGBT people and trans people specifically.
Sam: If you think these attacks are as coordinated as, shall we say, a large dance scene on a soundstage for Wicked – you’re right. There's been political strategizing behind these ban efforts.
Kellan Baker: A lot of the bans, particularly around medical care, are very similar to each other because they're coming from a pretty much a single source the Alliance Defending Freedom, America First Legal there's a whole sort of constellation of extremist right wing groups that have been pushing these kinds of bans. There are a number of general themes that tend to hold across the various states that have enacted bans on medical care. For example, criminalizing doctors threatening them with civil penalties or even with criminal charges. for providing best practice medical care to transgender young people. There are “tort reform provisions” in a lot of them making it almost impossible for providers to get malpractice insurance by extending the statute of limitations sometimes up to a decade or two or longer, and also expanding the rules about who can bring a malpractice lawsuit. So that has a real chilling effect, obviously, in the United States, being a litigious society. Some of the other things that we see include restrictions on quote unquote aiding and abetting. So this is coming directly from the anti- abortion playbook. This is where a state criminalizes anybody, in most cases a provider, for providing any information to a patient or their family about how to access care. So a young person in Oklahoma today, for example to pick just one state among many who needs information about how to access the best practice medically necessary care that their doctor is prescribing, their doctor cannot tell them anything about where or how to find that care for fear of being charged with aiding and abetting. The general themes are to criminalize providers, criminalize parents and close every route of escape or opportunity for trans young people who need care.
Sam: Everyone we've spoken to for this episode emphasized how personal testimony was ultimately the most effective tactic and the advocacy handbook. Giving testimony to law and policymakers is though a multi-pronged defense. And that includes not just personal testimony, but research policy and medical professionals. But fundamentally it's an emotional battle and personal testimony is key to that.
Richard: With all that in mind, here's what Jace told us about the experience of giving testimony and what it was actually like.
Jace Wilder: My first testimony was back whenever I was 20. I was the first trans person to testify that session about any of the bills. And so that made it even more terrifying because it felt like there was a lot of pressure on me to try and set the scene and set the mood for the rest of the session. And I experienced the first of what I call freeze outs, which is whenever a group of lawmakers, instead of asking you questions or making comments while you're sitting there in front of them, whenever you can respond, wait for you to step away and wait for you to have to go sit down. And they just talk about you like you're not even in the room. And that's exactly what happened during my first testimony was they just didn't ask anything. They waited for me to sit down. And then all of a sudden I start getting misgendered. The lawmaker who proposed the bill said that my gender goes all the way down to my fingernails and I can't change anything about it. And so my first testimony was both startling in the fact that I got that first sense of abuse from lawmakers in front of me, even though all I did was tell them the facts about what it was like to be trans in the state of Tennessee. But then I also had the community behind me who still were cheering me on, that were still rooting for me. telling me how proud they were, how happy they were to hear a trans voice speak, and that inspired me to continue to do testimony. And I would say, almost every single time, I have either had a “hot seat” moment where I do get asked a lot of ridiculous questions or very harsh comments while I'm still sitting there, or they freeze me out and wait till I sit down. And that experience of testimony can be so disempowering for trans people. But because of the community, it's still empowering because they hear my voice, and they still uplift me, and they still uplift the message that I was trying to get across in the first place.
[TRANSITION MUSIC]
Sam: Let's get into the different types of disinformation that are used to promote anti trans legislation. To help us do this, and one of the inspirations for this episode, is our third and final guest.
Meredithe McNamara: My name is Meredith McNamara. I'm an assistant professor of Pediatrics. I specialize in adolescent medicine. I use she and her pronouns. I am at the Yale School of Medicine, and my particular experience with this topic is that I am involved in expressing scientific truths in publicly accessible ways in written and spoken formats for litigators, legislators, the media, and the community at large, specifically regarding transgender identity and gender affirming care.
Gaby: Dr. McNamara focuses on the care of people ages 11 to 25, and given that many of the bans on best practices of trans care target folks under 18, her professional training and her clinical practice really put her in a very important position to speak about trans care for minors and young folks.
Meredithe McNamara: The testimony that I've been involved in has been very high stakes and dependent on specific, particularly toxic policies, whether that's a piece of legislation or a medical board rule or renewal of a particular funding stream. Now I think what people need to realize is this is not just state based legislation. These aren't just laws, right? Your state's medical board can make a rule that isn't legislation, doesn't get signed by a governor, but they still have comment periods, that sort of thing. Your local school boards can be making decisions that aren't legislative. So a lot of things are actually happening outside of the traditional concept of what lawmakers do.
Richard: Throughout those various arms of advocacy Dr. McNamara has seen various types of disinformation. She and colleagues in both medicine and law have published multiple papers on these disinformation themes including a framework for how to effectively combat this with scientific data supporting each claim against anti trans conclusions.
Sam: We're going to walk through her framework, which contains five themes, for the remainder of this episode. You can check out our show notes to see those themes summarized as well as links to her peer-reviewed publications. Our show notes will also have a lot of the studies and guidelines that are cited within these publications and the conversation to follow. But, back to Dr. McNamara for theme number one, which is false and misleading claims about gender identity.
Meredithe McNamara: False and misleading claims about gender identity. “This is just a phase,” you know, like “90 percent of kids who say they're trans aren’t." “What about all of the mental illnesses that young people have? What about cell phones and social media? Aren't these, young people just convincing themselves that they're trans?” “Teenagers don't know anything,” right? All of that casts doubt on the validity and the reality that gender diversity is real. It's been around since the beginning of time. Why are we doubting it en masse, like all of a sudden it's because of the restating of those types of things.
Richard: So just to list them out one by one the specific false claims that Dr. McNamara often finds stated are:
1) that social contagion is responsible for creating trans youth.
2) that gender dysphoria is a mental illness whose "proper" treatment should be therapy aimed at reversing the dysphoria rather than affirming the gender.
And 3) that a significant number of minors meaning those under 18 regret transitioning if given the opportunity to do so.
Sam: Each of these claims have been debunked and have peer-reviewed research to speak against those claims.
Richard: But we'll dive deeper into detransitioning one of the most common but also most harmful points of disinformation about gender identity.
Gaby: When we say detransitioning, we mean the narrative that someone who at one point identified as trans and accessed gender affirming medical interventions at a later point, stopped identifying as trans – and, related to that, stopped accessing gender affirming medical interventions.
Meredithe McNamara: It is exceedingly rare for somebody to later determine that they are not transgender. And to me, that is what people are trying to say when they talk about detransition. That they think that there's some lack of stability in people's gender identity that makes that initial decision to pursue this care a mistake. That's what people are trying to say. If somebody is talking about detransition, you might ask them, where are you getting this information from? They might cite a study of prescription medication utilization amongst adolescents who have TRICARE, the U. S. military insurance. And that study shows that a lot of teenagers don't fill their gender affirming medications when they turn 18. That's because a lot of people age out of TRICARE at that point. So that's where that comes from, right? You have to really just go down until you get to what's really going on. There is a study that came out of Australia recently – it’s the longest and largest follow up gender identity of adolescents into adulthood. And they had very few patients who experienced what they called “birth sex re-identification.” So it was a study published in JAMA and the first author is Cave. 99% of their cohort did not experience birth sex re-identification, right? I think the other problem with the popularized concept of detransition is the conflation of a change in medical care with regret. And that's not true for everyone. That's a highly individualized thing. What I want your listeners to know is that at the end of the day, the best available research, which is really solid is clear that it is exceedingly rare that somebody would later determine that they are not transgender.
Sam: To repeat something very important, a change in medical care does not equal regret.
Richard: I have patients who have stopped hormones for all kinds of reasons that were not related to a change in their gender identity. Some folks achieve their goals – like, some trans men who develop facial hair and start to pass could stop their hormones for a period of time. And then others stop taking hormones because our culture made living as a trans person too difficult for them to bear but not because their identity changed.
Sam: And that's just part of what makes the concept of detransition so prone to mis- and disinformation. And it's extremely variable in the way that someone's gender journey, including changes, gets labeled as “detransition.”
Richard: And among those who do make the decision to detransition meaning people who renounce their trans identity and take steps to move back towards their sex assigned at birth, we don't have a lot of medical information context. We have flashy news articles on detransitioning but we really don't know much about what kinds of assessments were done to help guide those folks to their kinds of gender affirmation.
Gaby: Look, in the grand scheme of things, we know that there are people, and you will read about them in the media, who do detransition. But again, big picture, those people are far fewer in number than those who are significantly benefiting from trans healthcare. And I'm talking life saving benefits, like the prevention of significant mental health burdens, including suicide attempts and suicidal ideation. And then when we think about trans kids who are allowed to be their affirmed gender...there are so many other dimensions of how they function psychologically and socially, how they're able to thrive and really have a beautiful developmental arc, because they are allowed to be trans, they're allowed to be the gender that they really feel they are and express that openly.
Richard: Here Jace highlights the shared humanity often lost in some of these debates about trans rights and detransitioning focusing on the need for care and unity.
Jace Wilder: So one of the things that I always want to point out is that detransitioners and people who are trans are both fighting for gender affirming care. Whether we want to recognize it or not, both individuals deserve equal access to gender affirming care, whether that means gender affirming care to bring them back to the sex assigned at birth or close to, or gender affirming care to bring them farther away from that. Those are both imperative needs, and we cannot take away from that because of the fact that whenever we talk about this detransition or “issue.” We are still talking about human beings. We are still talking about a person who is going through a transition process. Someone who has changed their identity and may be going back for a variety of reasons. One of the things that the political process has taken away from the story is that many detransitioners do not detransition because of the fact that they want to go back to the sex assigned at birth, but rather because of safety. A lot of them will end up transitioning again later in life because of the fact that the only reason they did transition is because they were not safe in the situation that they currently were, or they financially could not transition. And that is one of the big things that has been taken away in this conversation. As far as more nuance, the other issue is that trans people and detransitioners are not seen actually as two separate beings, but rather two sides of the same coin, and we're both used as political pawns in the same game. At the end of the day, a trans person and a detransitioner are still used in the same game of politics, and we both lose because of the fact that We aren't seen as human beings. And that is where I think that detransitioners and trans people need to make amends and need to understand that we need to be talking about this together and creating a middle ground together rather than further separating each other by participating in this game that has not been built for us but built against us.
Sam: Jace's comments dovetail nicely with another theme that Dr. McNamara discussed. That theme is false and misleading claims about the current medical standards of care and guidelines.
Gaby: So, for example, a very common question that I hear often is: “Isn't it dangerous or irresponsible to give kids trans healthcare because it's irreversible or permanent?”
Meredithe McNamara: If a young person with gender dysphoria, in the early stages of puberty, is given a puberty pausing medication to get time to consult with more clinicians, with their family, to learn more about themselves and to come to terms with this reality – that they're on a path that they can't get off of a medicalized conveyor belt that ends with irreversible interventions, right? That's a false claim about standard practices. Because what we do is actually very different. These are slowly paced conversations. They're often preceded by exorbitantly long wait lists, right? What is it? It's something like 2 to 3% of young people with a diagnosis of gender dysphoria actually receive any puberty pausing medications at all. So I'm not really sure how that ends up being a medicalized conveyor belt, right? So contorting, distorting standard practices to seem concerning or deviating from other types of medical care, you have to hit that point to get people to buy into a ban.
Sam: Lupron, the puberty pausing medication that Dr. McNamara mentions, is not estrogen and Lupron is not testosterone. Lupron pauses puberty and lets minors have more time to better understand their gender identity.
Richard: Not to mention that Lupron is used for other reasons in kids all the time. Kids who start puberty too young, kids who are going to be short to give their bones more time to grow, all kinds of reasons.
Gaby: The point is when it's done well and by the guidelines trans care for kids and teens is sensitively and gradually executed. It is not a rash decision and it often centers on these puberty pausers first. It isn't irreversible or permanent. And ultimately of the two to three percent of trans youth who do receive gender affirming care at all - meaning things beyond puberty pausing - the process (again when it's performed as dictated by best practice guidelines) is slow, patient and parent centered, and deliberate.
Meredithe McNamara: It's fascinating to me how popular people think surgery is for trans youth. That comes up over and over again, and what I say to people is, I have never had a patient desire a gender affirming surgery, first of all. A minor, a teenager, I just, I haven't had it, doesn't mean that it doesn't happen, but I've never seen that myself. What I see over and over again is that young people want to be listened to. They want to feel safe. They want to feel comfortable in their bodies. They want a group of people around them who affirm them and support them. None of those things are invasive, right? None of those things cause harm. All of those things are protective and they achieve what we generally all want young people to do, which is to thrive. The numbers on surgery are ridiculously low. So it looks like there have been about 200 top surgeries per year amongst people under the age of 18 from 2017 to 2021, 200 per year, right? So that is an extremely small percentage of young people who experienced gender dysphoria. It's 0. 001 percent of an extremely small proportion of young people in general.
Sam: To summarize that theme of disinformation: very rare medical interventions for minors are discussed like they're being passed out like Halloween candy in clinics.
Richard: Let's move on to our next theme the false claims about medical evidence for gender affirming care.
Sam: Dr. McNamara pointed out how there is an outsized level of scrutiny given to the normally conducted peer reviewed research that supports the guidelines for transgender medical care.
Gaby: And what we mean by outsized scrutiny is really that people are combing for some kind of a “gotcha” moment in the studies to confirm their own beliefs about trans care being harmful or bad. Here's Dr. McNamara describing what some of those critiques of the studies sound like.
Meredithe McNamara: So just saying "these studies don't show that these young people actually do any better when they get this care." "What is this care actually even accomplishing?" "The studies are bad. The studies are designed poorly". "The quality of evidence is low" or to take the technical term of evidence quality and to subjectify it actually, "the quality is weak, shaky foundations." Those sorts of things that cast doubt on the actual evidence,
Sam: As you can imagine, the scrutiny and the resulting conclusions that this scrutiny generates is all disinformation about the validity of the research. And this research does justify transaffirming care.
Meredithe McNamara: I've never gotten used to this exceptionalism about transgender people and gender affirming care that it gets held under a microscope and the light gets focused until it burns and then maybe we can understand what's going on. And whether people are over scrutinizing because they're intentionally bigoted or because they just genuinely don't understand because of that, systemic, prevalent bias against transgender people that kind of brews in the subconscious, like it's just as bad. So I would say that it's like the issues at hand are perplexing to people. That's not an excuse, right? I don't think it's okay to just throw your hands up and say I don't get all of this if you're a lawmaker, but that's really what's going on.
Richard: Yet another - we know, another - theme of disinformation is false claims about gender affirming medications. For example saying the trans affirming healthcare treatments prescribed "off label".
Meredithe McNamara: So then to make safety claims talking about how these treatments are off label, right? But neglecting the fact that 30 percent of prescribing in pediatrics and then widely in medicine just is based on things the FDA has never, you know just fully approved. That off label use of medication is normal and not weird.
Sam: Dr. McNamara's point is well taken, at least by us. We want to be super, super clear that many medications all across age spans of medicine are used without an FDA indication. That does NOT mean they are inherently unsafe if they don't have an FDA indication. A lack of FDA approval or indication also does not imply that there have not been robust studies done to evaluate a medication's use, safety, and efficacy for that specific reason.
Richard: One very common example of a medication that's used off label very frequently is the use of a lidocaine patch for back pain. Many people, some of my patients even, use lidocaine patches for back pain. But the truth is it's only FDA approved for called postherpetic neuralgia which is severe neurologic pain on their skin that people get after a recurrence of herpes
Gaby: So, there's the idea that these medications are prescribed off FDA indications, which, again, who really cares because we do it for literally so many other meds, but there's also a claim that trans affirming meds can cause very specific and, quite frankly, outsized medical harms.
Meredithe McNamara: Lots of other safety claims like cognitive development and puberty blockers seems to be the most recent one. So lots of people saying that putting a young person on a puberty positive medication will stunt their cognitive development. The responses to that are that the evidence has not demonstrated that – the evidence is not demonstrated changes in IQ points when these medications are used. That cognitive development in adolescence is based on a lot more than just the presence of sex hormones in the brain. It's based on peer relationships and psychosocial functioning. Having untreated gender dysphoria is a terrible way to go through adolescence and it's really hard to get your homework done and develop improved executive function when you're in the throes of serious distress. It's a safety claim that has become de rigueur of late but it's just like the others.
Sam: To summarize this theme: medications that are well-studied and guideline- recommended for minors are labeled in misleading ways that calls into question their use and safety.
Meredithe McNamara: And then finally the fifth theme: after you have doubted the existence of the condition for which care is being sought, made false claims about standard practices, the evidence, and the safety, then it's time to take down the medical organizations that back and support this care. It's time to go after the authority that has thoroughly and carefully vetted the evidence to make guideline driven recommendations on care. So that's where you start to see attacks on expertise come up.
Richard: Dr Baker touched on this too specifically around the policy and advocacy response to combating this flavor of disinformation.
Kellan Baker: So there has been a concerted effort to focus attention on the fact that there are expert standards of care in place for the provision of medical care to trans people, the World Professional Association for Transgender Health, for example, has maintained expert standards of care since 1979. The most recent, version 8, came out in 2022. And that standard of care is based on numerous independent systematic reviews, as well as the consensus and expertise of more than 100 experts in trans health from the U. S. and around the world.
Gaby: There are specific people out there trying to communicate that the data backing transmedical care is data driven and scientifically supported, but it's a hard argument to sell given the way that COVID and all of the events around COVID have really ruptured the relationship between the American healthcare system and its patients, clients, constituents, whatever you want to call us.
Sam: And, uh – that's not getting better any time soon. For anyone who's been reading headlines since the election, or at least trying to dodge reading the headlines, we would not call this moment in history a high watermark for trust in science.
Kellan Baker: So there has grown up this kind of very extensive degree of mistrust in a lot of corners of the U. S. population about scientific and medical authority. So you combine the sort of general problem of reaching people with information – for example, not that many trans people, not that many opportunities to talk about trans people in day to day life let alone medical care – you combine that with the difficulty of getting people information with making sure that they believe that information. And it's just a, an extremely difficult environment to be operating in. And so we're seeing just a lot of myths that continue to circulate even as we try to focus people's attention on the fact that this care is provided by licensed clinicians, according to expert standards of care that have been around for more than 40 years.
Gaby: When you combine disdain for scientific authority and transphobia, you're gonna get people that are pretty convinced that the disinformation they hear about trans care and trans youth in general is, in fact, very much real.
Richard: False claims about the organizations who make standards of care for transgender medicine was just one of the five themes of disinformation that Dr. McNamara described.
Sam: To recap, those themes were: one, false claims about gender dysphoria and the existence of trans identity. Two, false claims about evidence supporting trans medical care. Three, false claims about how common gender affirming interventions are. Four, false claims about the safety of gender affirming care. And five, false claims about the standards of care themselves.
Gaby: The framework Dr. McNamara provides is one that does help to convey the scientific reality that trans care is safe, it is data driven, and it is life saving. So if you don't plan to talk about Wicked at any future family meals, you can always bring the links to her research publications from our show notes.
[TRANSITION MUSIC]
Sam: We wanted to end by sharing our guests thoughts on the importance of showing up as an advocate in this process, however you are able to.
Meredithe McNamara: Concerned members of the general public, activists, allies, supporters can always show up with just a willingness to talk about these things to try to like, pleasantly debunk misinformation and disinformation. Just approach everything from the position of knowledge and expertise that, that a lot of people have about gender diversity.
Gaby: Because at the end of the day, these conversations, these moments of fighting disinformation, have really broad and far reaching importance.
Kellan Baker: It's not a niche issue. It's not about trans people. It never has been. It's not even about LGBT people. It's about a broad based political campaign to exclude the majority people from civic, political, public, social life. So this is about much more than trans people. This is about whether each of us has the opportunity to make incredibly personal, private decisions about our own bodies and our own lives. The fight around trans issues is deeply related to marriage equality, it's deeply related to abortion access, it's deeply related to structural racism, and the ways that so many people in this country have historically been denied the ability to make those incredibly personal decisions about their own lives.
Sam: To borrow Dr. Baker's words again: it's a hellscape out there. We hope that folks who both have or can access gender affirming care and especially medical professionals have a better understanding of the importance of public advocacy and that there are excellent frameworks such as Dr. McNamara's to help guide you in giving testimony.
Richard: Obviously not everyone is in a position where it's physically and emotionally safe to do that type of work, but we hope that whether you're inspired to march to your nearest legislative body, write to your policymakers, or work on education, that you now have more of a vocabulary to combat myths and disinformation about best practices for trans medical care.
Gaby: And with that, let's let Jace bring it home and hear from them one last time.
Jace Wilder: I think that I am speaking more to Tennesseans than I am speaking to the lawmakers, because the unfortunate thing that I have learned is the fact that they do not wish to have their minds changed for the most part, there are some that are still on that brink where you can tell that they shudder or shudder away from the sight of you whenever you're up there. They get shy and they still will vote with the party line, but you could tell that there's shame in it. But I'm talking to the Tennesseans who have been taught these false ideas and have question marks at the end of their sentences. When I talk to people, sometimes they will say, Things like trans people are this, right? And there's that question mark at the end. And I'm talking to the people that have that question mark. But I'm also talking to trans people who have been disempowered and been told that they don't matter. And giving them their voice back and saying that you can do this too. That it doesn't take an expert to talk about their story. It just takes someone having a moment of bravery.
I think that just final thought is just if you feel like you should speak out or that you want to find a way to, because your voice matters. Your voice is needed. And you can do it. You are qualified.
[QHP THEME MUSIC BEGINS]
Richard: QHP is a power sharing project that puts community stories in conversation with healthcare expertise to expand autonomy for sexual and gender minority folks
Sam: Thank you to our healthcare expert, Dr. Meredith McNamara and our policy expert, Dr. Kellan Baker. And as always, thank you to our community voice, Jace Wilder.
Gaby: For more information on this episode's topic, check out our website, www.queerhealthpod.com.
Richard: And please help others find this information by leaving a review and subscribing on Spotify or Apple podcasts.
Gaby: We are on Twitter or X and Instagram. Our handle at both is @QueerHealthPod. So please reach out to us
Sam: Thank you to Lonnie Ginsburg who composed our theme music and to the Josiah Macy Jr. Foundation who supported some of the tech we use to produce this episode.
Richard: Opinions in this podcast are our own and do not represent the opinions of any of our affiliated institutions. Even though we are doctors, don't use this podcast for medical advice. Instead, consult with your own healthcare provider