As of March 2021, we are seeing one of the most thorough and coordinated attacks on transgender people in both the United States and the United Kingdom since Donald Trump took office in 2016.
Laws have been introduced in the past couple of months aiming to levy felony charges against physicians who prescribe puberty blockers1, as well as to block transgender youth from participating in youth sports. A bill in Montana would allow for criminal charges to be pressed against any youth 13 or older who attempts to play sports on teams in accordance with their gender if their gender identity does not match the sex they were assigned at birth. One such bill in Georgia would require a genital exam by a panel of at least 3 physicians for transgender girls who wished to play school sports. Some of these have already passed, and are in the process of being signed into law.
Anonymously curated registries of “gender offender” doctors— physicians who treat transgender, nonbinary and gender-expansive children— have popped up all over the internet and include personal information on providers, including but not limited to where they live and where they work. In the past three months, protests have occurred outside multiple Children’s Hospitals with signs depicting botched or complicated surgeries— mirroring a tactic we’re all too familiar with on the anti-choice right wing. Billboards have popped up around clinics and hospitals targeting the parents of transgender youth.
So how did we get here?
While the idea had first started circulating in 2016, it wasn’t until 2017 that a social worker named Lisa Marchiano published a paper in Psychological Perspectives that claimed there was an “epidemic” of youth identifying as transgender. Citing a rise in self-identification among assigned female at birth (AFAB) teenagers, Marchiano postulated through a mix of Jungian psychoanalysis (more specifically the belief in a ‘collective unconscious’) that a “psychic outbreak” was happening, and the field of mental health needed to respond accordingly. Marchiano was not alone.
In response, a then-professor at Brown University School of Public Health, Lisa Littman, recruited participants to outline the alleged phenomenon, an effort that was eventually published in the high-impact journal, PLoS One. Quickly, Littman’s work was rebutted by experts in the field who highlighted substantive methodological problems with Littman’s study that should have prevented it from passing Institutional Review. Most notably: Littman did not recruit the very people about whom she was writing, but rather their parents.
The message boards and forums from which Littman drew her participants were from an increasing fringe group of parents who had become alienated from their trans children after rejecting them when they came out. Many were estranged from their children, some had engaged in legal battles. All of them believed that their children had spontaneously become convinced they were transgender overnight through peer influence. PLoS subsequently issued a long correction to Littman’s work, questioning the interpretability and methods of her study. Experts in trans healthcare made short work of it, and soon “Rapid Onset Gender Dysphoria” (ROGD) as Marchiano and Littman proposed to call it, was relegated appropriately to the realm of pseudoscience. But the damage was done.
Bigotry makes for strange bedfellows, and the far-right continued to run with the idea of ROGD in the background. Regnery Publishing, a far-right think tank and publishing house that publishes books by reactionary political figures such as Ted Cruz, Donald Trump and Nigel Farage secured a contract with former attorney Abigail Shrier to commission a book called “Irreversible Damage: The Transgender Trend Seducing Our Daughters”. Shrier’s work models Littman’s recruitment style, but without any scientific oversight. The book became a bestseller, and was named one of the The Economist’s Best Books of 2020. This is not, however, a strictly United States phenomenon.
The ideas promoted by people like Marchiano struck a chord with reactionaries in the United Kingdom, and provided the theoretical basis for one of the most damaging lawsuits to LGBT people in the country in recent memory. Just as 2020 drew to a close, a now infamous legal case was playing out in the UK high courts, in Bell v. Tavistock. Kiera Bell is one of a number of “detransitioners”, people who at one time identified as transgender, but no longer do. Kiera was seeking a permanent injunction against gender-affirming treatment without a court order. Bell’s case was litigated on their behalf by Paul Conrathe, a solicitor whose primary claim to fame prior to the Bell case surrounded his vocal opposition to abortion access within the National Health Service. In both circumstances, he argued in favor of statutory limitation (or elimination) of bodily autonomy for patients. Conrathe’s law firm believes that only judges have the sense to decide who can do what with their bodies, and how.
The day of the Bell v Tavistock ruling, the NHS shut down access to gender affirming care for all children in the entire UK. Groups masquerading as concerned parents and trans-exclusionary LGB groups coordinated call in campaigns and phone zaps, shutting down pharmacy access for trans patients, regardless of age. After a protracted smear campaign against one of the leading gender affirming care providers in the UK, pharmacies stopped honoring all prescriptions from the clinic whatsoever, leaving thousands without access to life-saving medications.
Now it’s happening here in the United States. This coordinated attack on trans rights has now seen over 50 bills introduced in the US in the past two months that penalize transgender people for everything from accessing medical care to using the bathroom or playing softball. As is consistent with their political position, the National Association of Social Workers has yet to make a single statement about the issue. A cursory google search of the Alabama chapter of NASW— where some of the most extreme anti-trans bills have been introduced— shows that the word “LGBT” appears exactly zero times on their website.
While this current crisis was cooked up by the far right, it was made possible by complicit actors within the fields of medicine, social work and public health, and despite ample opportunities and platforms on which to speak up, few organizations have spoken directly to these attacks, instead choosing to make vague platitudes about valuing the lives of trans people.
If social work, medicine and public health truly value the lives of transgender people, this support must be explicit. But there also must be consequences for those who would use their professional prowess to target trans youth. These bills are only the newest conflagration of anti-trans sentiment turned action, but they may be the deadliest yet. The anti-trans bills of 2021 are spreading like wildfire and the person who lit this match is herself a social worker.
The stakes in mental healthcare are equally enormous: in addition to the US and the UK, support is gaining in Canada for “therapy” for trans youth that treats gender dysphoria as a mental illness. We are currently seeing a wave of support from previously ostracized “professionals” like Kenneth Zucker2, whose well-known practice of encouraging parents to punish gender-nonconforming children saw him removed from the Center for Addiction and Mental Health (CAMH) in Ontario. Efforts to ban “therapy” like Zucker’s have stalled out in the UK due to unlikely support from government officials and lukewarm opposition from UK healthcare organizations.
Zucker has allies in the ROGD fight. Ray Blanchard, the man whose dangerous fantasies about transgender women manifested in the public imagination in movies like the Silence of the Lambs— equating transgender people assigned male at birth in the minds of the public with depraved killers— was the person who posted that 2016 comment which sparked Lisa Marchiano’s original article. Blanchard has seen a resurgence, with Blanchard and Zucker becoming darlings in the fight to legalize conversion therapy in all three countries. To do so, they have joined forces with the far right who is currently litigating against conversion therapy bans from the perspective that such a ban would constitute an imposition on religious freedom.
Trans youth need our support, and trans people are exhausted from fighting this battle alone. Bodily autonomy and access to healthcare are of critical importance to all people, and anyone who has had to fight to seek out, receive, or pay for life-affirming care knows this. But right now the targeted denial of these basic rights is killing trans people. Vocal and visible support are needed now so that all trans folks have a future to fight for.
- “Puberty blockers” are medications that suppress the production of gonadotropin releasing hormone (GnRH) and are known as GnRH antagonists and GnRH agonists, depending on the medication. GnRH drugs interrupt the endocrine processes that facilitate endogenous puberty, and are used to allow children time to make informed choices about their bodies without irreversible secondary sex characteristic development.
- In the interim, in the face of growing evidence of the dangers of these practices, Zucker has remained editor at the Archives of Sexual Behavior and a professor at the University of Toronto.