At the Medical University of South Carolina (MUSC), a noxious combination of political ambition, billionaire privilege, and bureaucratic cowardice led the academic hospital to cut off gender-affirming care to minor patients, including patients younger than what the institution’s right-wing detractors had demanded.
In September 2022, opponents of gender-affirming care in South Carolina latched onto a parenthetical included in a medical student’s graduate research at MUSC. The parenthetical comment described the youngest transgender patient to visit the hospital’s pediatric endocrinology clinic, just 4 years old, according to a report from ProPublica.
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That fact morphed into fiction as far-right critics inaccurately claimed that children that young were prescribed hormones as part of gender transition therapy at the hospital.
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None other than gender-critical transphobe and X owner Elon Musk amplified the false claim, posting, “Is it really true that four-year-olds are receiving hormone treatment?” His post led federal and state lawmakers to interrogate hospital leaders about whether the public hospital was, in fact, helping young children medically transition.
The truth was that the hospital didn’t offer surgery to minors as part of their gender-affirming care offerings, nor did any patients receive hormone therapy before puberty.
The facts, however, didn’t matter.
“If MUSC is mutilating or castrating children, I won’t stop until they are stripped of public funding,” Republican state Rep. Thomas Beach of South Carolina’s Freedom Caucus, threatened in an X post.
The South Carolina legislature had already banned the state’s flagship medical university from using public money to provide any treatment “furthering the gender transition” of children under 16, and hospital leaders assured lawmakers they didn’t use state money to care for trans patients.
But over the next several months, hospital administrators went even further in an effort to evade scrutiny from lawmakers, the press, and the far-right outrage machine. MUSC cut off all gender-affirming care for anyone under 18, while abandoning all previous patients with no explanation or advice for their continued care.
That autumn — as pressure mounted on the hospital from state lawmakers and those anxious to exploit the culturally divisive issue for political gain — U.S. Rep. Nancy Mace (R-SC) was locked in a contentious race against her Democratic opponent Annie Andrews, a pediatrician at MUSC who wasn’t connected to the endocrinology clinic. Mace exploited the connection, and placed trans kids at the center of the controversy.
In a tabloid-style video from Mace, text scrolled over a photo of Andrews: “Sex change surgery, puberty blockers, gender changing hormones for children?! That’s not protection. That’s child abuse.”
Hospital administrators dissuaded pediatric residents who wanted to publish a letter defending Andrews against Mace’s political attacks, for fear it would invite more scrutiny.
“They left me out on a limb,” said Andrews, who has since resigned from the hospital.
The state’s far-right Freedom Caucus also reveled in their charge to strip MUSC of funding because of the hospital’s perceived pro-LGBTQ+ bias.
After MUSC leaders agreed in December to cut off access to hormones for gender transition for minors of all ages — including 16- and 17-year-olds — state Rep. Beach crowed on Facebook, “I went after the Medical Center of South Carolina with 19 other of my door-kicking, rock-ribbed, and South Carolina’s most Conservative legislator friends. It feels good to be a gangster.”
New data shows a record-breaking number of businesses are displaying true LGBTQ+ allyship to their employees, proving they “aren’t buying” mounting anti-LGBTQ+ rhetoric.
The Human Rights Campaign (HRC) Foundation issued its Corporate Equality Index (CEI) this week, and determined that the workforce is “more allied than ever before.”
The CEI, launched by the HRC Foundation in 2002, is a survey that measures company policies and practices regarding LGBTQ+ equality.
In its first year, 319 businesses participated to determine if their policies were up to scratch. This year, 1,384 companies took part in the review – and the results were overwhelmingly positive.
The CEI reports that a record-breaking 95 per cent of businesses reviewed have non-discrimination protections in place specifically regarding gender identity. That’s an exceptional jump from 2002’s five per cent.
Equally as promising is the 94 per cent of businesses that offer transgender-inclusive health insurance coverage to employees, compared to 0 per cent in 2002.
Noting that these exceptional figures come at a time when the LGBTQ+ community is under attack by people “hoping to eradicate our identity and push us back in the closet”, HRC President Kelley Robinson said that it looks like “businesses aren’t buying it.”
“The future workforce is more out and allied than ever before in our nation’s history, and this year’s CEI shows a business community looking for ways to further support LGBTQ+ workers and their families,” she added.
This year’s review also found that 70 per cent of CEI-rated businesses have guidelines and supportive policies and guidance in place to pro-actively support employees going through a gender transition, as well as their managers and colleagues.
And 63 per cent of the businesses have policies that ensure a safe and affirming environment for transgender and non-binary employees, including trans-inclusive or all-gender restrooms, gender-neutral dress codes, and how an employee’s information, such as name and pronouns, is displayed.
Of the businesses reviewed by the HRC Foundation this year, an impressive 545 companies scored a perfect 100 and will be honored with HRC’s Equality 100 Award as Leaders in LGBTQ+ Workplace Inclusion.
Companies that took part in the CEI rating range from Fortune magazine’s 500 largest publicly traded businesses, American Lawyer magazine’s top 200 revenue-grossing law firms (AmLaw 200), and hundreds of publicly and privately held mid- to large-sized businesses.
Among the companies that earned a perfect score were household names like Apple Inc., AMC Entertainment, Dominos Pizza Inc., Goldman Sachs Group Inc., Google Inc., Mars Inc., Paramount, Pfizer Inc., Visa, and Warner Music Group – to name but a few.
Commenting on this year’s optimistic findings, Rashawn Hawkins, the HRC’s Senior Director of Workplace Equality, said: “For well over two decades, businesses have played an important role in furthering LGBTQ+ equality by centering employee needs and voices when it comes to workplace inclusion.
“While there is much more work to be done, year-over-year growth in CEI participation is evidence of a business community that recognizes the responsibility and value in upholding equity and inclusion.”
Any queer person who’s spent time on the internet has no doubt heard the tired, dismissive right-wing argument that LGBTQ+ folks are just some recent fad, that some nebulous combination of the internet, declining western values, and their favorite boogeyman, “Cultural Marxism” are to blame for the rise in visible, out queer people. This is a favorite refrain, especially when it comes to transgender folks, as anyone who’s faced the pain and ignominy of being called a “trans-trender” is well aware.
The truth, of course, is very different. The historical record is replete with individuals who in one way or another chafed against the gender and sexuality norms of their time, or in some cases subverted, ignored, or flaunted them entirely. There are countless examples of such people on record, and countless more who surely existed but were never recorded.
The stories of the individuals to follow are just a few examples of gender-nonconforming people whose lives were, at least in part, recorded in extant documents.
Note that these people are from a time period in which the word “transgender” did not exist in the public vocabulary, and thus it is rarely possible to be certain of how they might have identified, given the choice. Further, records from these eras rarely state such details as preferred pronouns. In the interest of extending respect and the benefit of the doubt, the names and pronouns used here will reflect the outward presentation these individuals seemed to prefer based on existing evidence.
Mary Jones (1803-Unknown)
Frequently considered to be either the first or one of the first transgender people ever recorded in an official capacity, Mary Jones was a Black American soldier and sex worker. While it cannot be determined for certain if Jones would have identified as a transgender woman if given the option, she is at the very least a prominent gender-nonconforming historical figure.
Mary Jones was AMAB (assigned male at birth) and would reportedly present as male during the day and female at night, wearing a dress, wig, and feminine jewelry. She used a prosthetic vagina in order to solicit sexual interactions with men at night, during which she would allegedly pickpocket their wallets.
Jones is most well-known for the June 1836 court case in which she was charged with Grand Larceny as a result of alleged pick-pocketing of her sex work clients. She was tried on June 16, 1836, five days after a white mason named Robert Haslem discovered his wallet containing $99 had been replaced with an empty one after soliciting sexual services from Jones.
Jones appeared in court in her female-presenting attire, a fact for which she was widely mocked and ridiculed by the court and the audience. Upon having her choice of attire questioned, Jones said:
I have been in the practice of waiting upon girls of ill fame and made up their beds and received the company at the door and received the money for rooms and they induced me to dress in women’s clothes, saying I looked so much better in them and I have always attended parties among the people of my own colour dressed in this way — and in New Orleans I always dressed in this way —
During the trial, Jones also mentioned her prior military service, which was offered as a plea for the jury’s forbearance. She flatly denied having ever laid eyes on Haslem, let alone stealing from him.
Despite pleading not guilty to the charge of Grand Larceny, Jones was ultimately convicted and sentenced to five years imprisonment in New York’s Sing Sing.
Few specifics about Jones’ life are known beyond this point. She did survive to be freed after her five-year sentence and was eventually arrested again in 1845 for once again presenting as a female sex worker and allegedly stealing money from her clients. She was released from Blackwells Island on February 15, 1846 after serving a sixth-month sentence for the repeat offense.
The details of her later arrest and imprisonment are known only because they were reported on by the Commercial Advertiser and the New York Herald. No extant records exist about her life after this point, nor is the date of her death known.
Though incessantly mocked in her time, Mary Jones has since been celebrated by historians and queer activists for her refusal to give up presenting as her authentic self even after arrests and imprisonment. She is likewise lauded for her candor when sharing her experiences as a Black gender-nonconforming person to a primarily white courtroom audience, in spite of receiving nothing but ridicule for doing so, even having her wig violently removed according to reporting by The Sun. She clearly did not let said ridicule dissuade her from living as her authentic self, given later reports of her continued public presentation as female.
Albert Cashier (1843-1915)
It’s generally prudent to avoid making hard assumptions about the gender identities of people long since dead who lacked the language that exists today for expressing such things, but every once in a while one comes across a standout example of someone who, by all accounts, unambiguously lived the life of someone who would today be called transgender.
Albert Cashier, born in Ireland December 25, 1843, is one such person. Reports on his early life are contradictory and uncertain, but two things seem apparent: that despite being born AFAB (assigned female at birth), Cashier preferred to present as male from a young age, and that at some point in his early life, he traveled to the United States as a stowaway and settled in Belvedere, Illinois.
From there, records paint a somewhat clearer picture. Cashier enlisted to serve in the Civil War in July of 1862. On August 6 of the same year, Cashier officially enlisted in Company G of the 95th Illinois Infantry under the name “Albert D.J. Cashier.”
Cashier and his regiment fought in approximately 40 battles, including the Siege of Vicksburg. At one time, Cashier was captured during reconnaissance but managed to escape and return to his company.
After exemplary service in the war, Cashier returned to Belvedere, Illinois in 1865. He later settled in Saunemin, Illinois, in 1869. He would continue to live there for over forty years, and across his time in both towns, he earned his keep with a variety of odd jobs, including but not limited to church janitor, lamplighter, farmhand, and cemetery worker.
Later in life, Cashier fell ill, and his birth sex was discovered three times over the ensuing years. First, probably around 1907 (records are unclear) by his neighbors the Lannon Family, with whom he was friends. The Lannons elected to keep Cashier’s secret.
In 1911, when he broke his leg in an automobile accident, the hospital physician who treated him again discovered his birth sex, and like the Lannons, chose to keep Cashier’s confidence.
Sadly, Cashier was less lucky at the end of his life. In March of 1914, he was confined to the Watertown State Hospital due to a deteriorating case of dementia. Attendants at the hospital again discovered that he was AFAB. Unfortunately for Cashier, this time, the secret was not kept. Instead, he was forced to wear women’s clothes again after a lifetime of comfortably presenting as male.
Cashier died on October 10, 1915, tragically denied the right to live as his authentic self in his final years, as he had successfully done for the rest of his life prior to the onset of his dementia. There were, however, two silver linings. First, despite having been investigated for fraud after the discovery of his birth sex, the Veterans’ Pension Board—after speaking with the surviving members of Cashier’s regiment—elected to continue Cashier’s payments for life.
Secondly, Cashier was buried in full military uniform, his tombstone inscribed “Albert D. J. Cashier,” granting him in death the authenticity he was denied in his last years of life.
The Public Universal Friend (1752-1819)
The individual who would come to be known as the Public Universal Friend was born on November 29, 1752 under the name Jemima Wilkinson in Cumberland, Rhode Island. In the other stories presented here, birth names have been omitted out of respect. In the Friend’s case, however, there is no indication of discomfort with the name and sex they were assigned at birth, prior to a very specific point in their life.
Wilkinson was born to Quaker parents and grew to be both an athletic and studious child. Wilkinson was an avid reader, able to quote long passages of the Bible and prominent Quaker texts from a young age, as well as a skilled equestrian favoring energetic, spirited horses.
Little else is known about Wilkinson’s childhood, though some reports suggest they detested physical labor and favored fine, expensive clothing. These reports are considered somewhat suspect, however, as it was common at the time to fabricate narratives of decadent lifestyles to discredit those who experienced religious awakenings.
The mid-1770s represented a period of upheaval and shifting views in both Wilkinson and several other members of their family. Wilkinson began attending meetings with the New Light Baptists in Cumberland, who emphasized individual enlightenment, and let their attendance of meetings with the Society of Friend lapse. Wilkinson was ultimately dismissed for this lapse, as were several of their siblings for other reasons; their sister Patience for bearing an illegitimate child, and their brothers Stephen and Jeptha for training for military service, a violation of the Society’s pacifistic ideals.
In the wake of this upheaval, Wilkinson was stricken ill in October of 1776. Their affliction was an epidemic disease of some sort, most likely typhus. For several days, Wilkinson was on death watch, with their doctor, family, and friends unsure if they would survive.
After several bedridden days, the fever broke. Wilkinson’s body had survived the ordeal, but reported that Jemima Wilkinson had in fact died and ascended to heaven, and that the surviving body was now inhabited by a genderless spirit sent by God to preach his word: the Public Universal Friend.
From this point on, the Friend refused to answer to the name, “Jemima Wilkinson,” asking to be referred to only as the Public Universal Friend, or simply “the Friend” for short. The Friend further requested that no gendered words or terms of address be used to refer to them, stating that they were neither male nor female. They dressed in clothing considered either androgynous or masculine at the time, including long, loose clerical robes and a cravat or kerchief. When asked whether they were a man or a woman, the Friend responded by stating simply, “I am that I am.”
The Friend began to travel, preaching and amassing followers in what would come to be known as the Society of Universal Friends. They preached throughout Rhode Island, Connecticut, Massachusetts, and Pennsylvania, accompanied by their siblings, all of whom had been disowned from the original Society of Friends.
The content of the Friend’s sermons was very similar to that of the mainstream Quaker faith, preaching humility and hospitality to all, repentance of sins, pre-marital abstinence, and other common Quaker beliefs. The primary difference was that the Friend appears to have been overall more forgiving, welcoming all to join their flock, even if they had been disowned by mainstream Quakerism. Due to the Friend’s preaching of gender and racial equality, the Society of Universal Friends included many Black members and roughly equal numbers of men and women.
The Friend continued preaching until the death of their sister Patience in April 1819, upon whose funeral they gave their final sermon, before dying later that year on July 1. Though the Society of Universal Friends would gradually die out over the ensuing decades, the Friend left a lasting legacy due to the remarkable nature of their claims. The nature of their supposed death and resurrection, as well as their gender (or lack thereof), has been greatly debated since. The Friend’s rejection of gendered terminology and insistence that they were neither male nor female has led many to view them as a celebrated nonbinary figure from early American history.
Willmer “Little Axe” Broadnax (1916-1992)
Willmer Broadnax was born in Houston, Texas in either 1916 or 1922; records are uncertain due to confusion about his early life. Most sources refer to Willmer as the younger brother to William Boradnax. However, at least one source posits that Willmer was merely mistaken for the younger of the two brothers due to his short stature and high voice.
Either way, what is clear is that Broadnax was AFAB but presented as male from a very young age, possibly as early as 8 years old, if not earlier. In his teenage years, he began a career as a gospel singer with the St. Paul Gospel Singers, alongside his brother William.
The brothers remained with the St. Paul Gospel Singers for about a year, from 1939 to 1940, before breaking off to form their own quartet, Little Axe and the Golden Echoes. While William would eventually leave the group, Willmer remained as a lead singer through most of the 1940s.
The Golden Echoes eventually disbanded in 1949, and Willmer’s gospel career continued until 1965 with several different groups, such as the Spirit of Memphis Quartet, The Fairfield Four, and the Five Blind Boys of Mississippi. After retiring, he continued to occasionally produce new material with the Blind Boys through the 1970s and into the 80s.
Broadnax would meet a violent end in 1992 at the hands of his lover, Lavina Richardson. Broadnax had seen Richardson in a car with another man and, in an act of jealousy, bumped into the car with his own and dragged Richardson out of the vehicle and threatened her with a knife. Broadnax was subsequently disarmed by a bystander and stabbed to death by Richardson, who had picked up the knife he dropped. Richardson would later be found guilty of involuntary manslaughter; while it wasn’t quite self-defense (Broadnax had already been disarmed), Broadnax’s jealous behavior had allegedly been affecting Richardson’s mental health, prompting the judge to show leniency.
It was only discovered after Broadnax’s death that he was AFAB, meaning he managed to effectivey live an entirely lifetime presenting as male. While his short stature, naturally high voice, and apparent preference for always using the restroom alone did draw occasional suspicion, he was only ever outed posthumously.
***
The figures spotlighted here are only a drop in the ocean when it comes to the preponderance of gender-nonconforming individuals throughout history.
The recent rise in visible, out queer folk is just that, a rise in visible and out queer people; they’ve always been here, but it hasn’t always been safe to be open about it. It still isn’t, but too much progress has been made towards acceptance to give up now.
The Human Rights Campaign (HRC) has come under fire for endorsing Starbucks, despite the coffee chain’s alleged anti-union and anti-LGBTQ+ actions over the past year.
As part of its 2023-2024 Corporate Equality Index report, the human rights group listed Starbucks Corporation among several other companies to gain a perfect score of 100 for its LGBTQ+ rights protections.
The HRC wrote that the score was given to companies that it believed “took concrete steps to establish and implement comprehensive policies, benefits and practices that ensure greater equity for LGBTQ+ workers”.
But the decision has been met with widespread criticism from LGBTQ+ activists who have argued the company has used LGBTQ+ rights as a threat in its anti-union campaign over the past few years.
Following a string of Starbucks locations unionising throughout 2022 and 2023, staff have alleged that gender-affirming care benefits under the company’s healthcare plan could be dropped if unionisation continued.
Speaking to Bloomberg in June 2022, one trans member of staff claimed that her manger used a “veiled threat” to prevent unionisation, suggesting that trans-healthcare-related benefits could worsen if a union was formed.
A spokesperson for Starbucks told CNBC at the time that the claim was false.
A similar story in June this year had the report that Starbucks workers had alleged that the company prevented staff putting up Pride decorations in one outlet.
“If Starbucks was a true ally, they would stand up for us, especially during a time when LGBTQ+ people are under attack,” a statement from Starbucks Workers United (SWU), which first aired the allegations, said.
“A company that cares wouldn’t turn their back on the LGBTQ+ community to protect their already astronomically high profits.”
In a statement given to PinkNews, Starbucks said that no change to corporate policy on Pride decorations had taken place and that it was still “unwaveringly” supportive of the community.
“Starbucks has a history that includes more than four decades of recognising and celebrating our diverse partners and customers – including year-round support for the LGBTQIA2+ community,” the statement read.
Strike action was scheduled in June after the SWU claimed that unfair labour practices and a “refusal to bargain over changes in Pride decoration policies” resulted in “hypocritical” treatment of queer workers.
Starbucks award
At the time of reporting, more than 366 Starbucks outlets, with more than 9,100 employees across the US, have unionised.
Workers are currently pressing for a higher minimum wage to help tackle the cost of living crisis, as well as fighting for “fair scheduling procedures” and guaranteed minimum hours for workers.
The company has been accused by several groups and political figures of employing union-busting tactics.
In March, senator Bernie Sanders clashed with ex-Starbucks chief executive, Howard Schultz, after the former presidential candidate accused the coffee giant of “the most aggressive and illegal union-busting campaign in the modern history of our country”.
In response, Schultz said he was confident that Starbucks had not broken the law and that officials “want to treat everyone with respect and dignity”.
The HRC gave the company five out of five for workforce protection criteria and a perfect score for corporate social responsibility.
HRC also awarded top marks to the Walt Disney Corporation, which just last year was heavily criticised for removing a same-sex kiss from the animated film Lightyear.
Throughout the late 80s, 90s, and early 2000s, Americans became obsessed with anabolic steroid doping – i.e., hormonally altering one’s body to win sports competitions. In 1988, American Olympic sprinter Ben Johnson lost his gold medal from the Seoul Olympics due to doping with anabolic steroids. This was considered a national embarrassment, and after a series of hearings, the Anabolic Steroids Control Act of 1990 was passed as part of the Crime Control Act.
Twenty-seven steroids, including testosterone, were classified as Schedule III drugs and subject to imprisonment and fines for possession and distribution. Then-senator Joe Biden was invested in this issue, saying at the time, “I think you are going to see, over the next several years, some real backlash from the public about sports in America… There is a feeling of resentment that is growing, and I do not know how it will manifest itself.”
Unfortunately, moral panic over steroids has always had the criminalization of transmasculine people as collateral damage. Prior to 1990, FTM Newsletter was known to suggest getting around pricey American testosterone by trafficking it across the border. One September 1989 ad read, “Vacationing in Mexico? One of our members asked us to inform any FTM’s visiting Tijuana, Mexico, that he was able to purchase Depo-Testosterone in a 10 ml vial over the counter for $18.”
In contrast, the September 1990 issue of FTM Newsletter informed its readers that they would have to ask their doctors to lie on their prescriptions if they wanted to have a stockpile of extra testosterone in their home – a useful thing to have in the case of shortages or rejections from transphobic pharmacists. These rejections are all too common because many states require people to show their photo identification (potentially revealing one’s dead name and legal sex) and log their prescription in prescription drug monitoring programs (often under one’s dead name) for them to be able to access testosterone.
The criminalization of simple possession and the risk of being accused of encouraging drug trafficking across borders has chilled discussion of trying to get hormones abroad or on the gray market. Do-it-yourself transition communities today, which allow discussions of gray market estrogen, ban discussions of how one might acquire testosterone. The fear of prosecution is not unfounded; transmasculine folks have reported being arrested for possession of testosterone they acquired legally. If law enforcement were to decide that a transmasculine person was possessing testosterone illegally, their first offense could land them up to a year in prison and a $1000 fine.
One would hope that the passage of the Anabolic Steroids Control Act of 1990 would satisfy politicians and a populace obsessed with steroids, but one would be wrong. Between 1998 and 2006, American politicians and NGOs purposefully engineered a second anabolic steroid moral panic. The anti-steroid propaganda many millennials probably experienced as children has roots in a Salt Lake City, Utah Olympic bribery scandal and the way cisgender men in power tried to save face in the aftermath.
The Winter Olympic bid scandal
In 1998, it was revealed that the president and vice president of the Salt Lake City bid committee had allegedly paid a total of over $1 million in cash and gifts to bribe over a dozen International Olympics Committee (IOC) officials in the hopes that their city could host the 2002 Winter Olympics. The president and vice president (who were indicted in 2002 but acquitted in 2003) allegedly also pocketed $130,000 in bribes from the hospitality company Jet Set Sports. Three other Americans were indicted for fraud, and one became a fugitive of the law. Shortly after, the news broke that similar bribery and fraud may have taken place when bidding for the Atlanta, Georgia; Nagano, Japan; and Sydney, Australia games.
It came as no surprise to journalists at the time that the IOC would wish to rebrand itself as an upstanding organization leading the charge against corruption in sports. The IOC looked to the United States for suggestions on how to clean up its image. The Office of National Drug Control Policy (ONDCP) recommended that it create an Olympic anti-drug agency and stated that the US was open to committing $1 million for research into new anti-drug tests.
In February 1999, the IOC unveiled the World Anti-Doping Agency (WADA), which sought to curb the use of performance-enhancing drugs. WADA received $25 million from the IOC to level up its bureaucracy, with hopes that this would eventually be subsidized by governments – though, as Scientific American noted at the time, WADA was “unwilling to put its full support behind experimental tests that might not withstand legal challenge in the Court of Arbitration.”
In 2000, President Bill Clinton created the White House Task Force on Drug Use in Sports, emphasizing that it came from concern for “the health and safety of America’s athletes, in particular our Nation’s young people” and “the integrity of honest athletic competition.” He cited the 1999 Monitoring the Future Study and claimed that it found that “steroid use among young people rose roughly 50 percent among both sexes and across all age groups.” This was a lie. For all young people, the number jumped from 1.4% to 1.9% between 1998 and 1999. But it sounded true enough to give the task force legitimacy.
Shortly after, the US Olympic Committee launched the US Anti-Doping Agency (USADA). USADA launched playclean.org as a hub for propaganda and began producing anti-doping commercials, print ads, and handbooks for coaches that conflated anabolic steroid use with the use of addictive drugs. In 2000, the White House Task Force on Drug Use in Sports met for the first time in Salt Lake City, accompanied by Mitt Romney (then-President of the Salt Lake City organizing committee), Mike Leavitt (then-Governor of Utah), and many other government and NGO representatives and athletes.
Experts who attended the meeting expressed the desire to push the federal government to close loopholes on steroid precursors and prosecute steroid possession and sale more harshly. Both the White House Task Force on Drug Use in Sports and the USADA fixated on how youth might admire athletes who use anabolic steroids and how they might access steroids on the internet.
As usual, this stigmatization came at a cost for transmasculine people. In the Fall 2002 issue of FTM Newsletter, trans man Marcus de María Arana wrote an article called The High Price of Manhood in which he described medical neglect at the UCSF ER that caused him to experience septic shock and lose 25% of his femur after a botched testosterone injection. According to Arana, “[T]he prevailing attitude was that I brought this upon myself by messing around with steroids… I got the vibe from some providers that I had gotten what I deserved for messing with nature.”
The aftermath
In 2004, Utah Republican congressman Orin Hatch and then-Senator Joe Biden cosponsored the Anabolic Steroid Control Act of 2004, which was framed as a way to stop health food stores from selling shady products, to demand an investigation into whether stronger sentencing was necessary, and to award grants to organizations that would distribute anti-steroid propaganda. Considering that Hatch was the architect of a 1994 law that allows supplement companies to avoid federal regulation (which has resulted in deaths), it’s tough to believe that Hatch was more invested in consumer safety than the reputation of the state of Utah. Biden expressed nationalistic concerns at a hearing in March 2004, saying, “There’s something simply un-American about this. This is about values, about culture, it’s about who we define ourselves to be.”
According to Hooton, “When I put three words into the Google search engine: ‘buy, steroids, online,’ over three hundred thousand sites popped up. Senators, all our kids need are a credit card number or a money order to have hardcore prescription anabolic steroids shipped right to their doorstep.”
Joe Biden claimed that half of all children believed that their favorite sports stars used steroids and called it “a devastating idea.” The Anabolic Steroid Control Act of 2004 was passed, and by 2006, sentencing guidelines for steroid possession and distribution became much more severe.
Meanwhile, Joe Biden’s political stock has risen, thanks largely to his reputation as a bipartisan negotiator of bills like the Anabolic Steroids Control Act of 2004.
Biden is sitting President of the United States at a time in which transmaculine folks’ increased visibility has prompted fearmongering books such as Abigail Shrier’s Irreversible Damage: The Transgender Craze Seducing our Daughtersand legislation restricting transition of all kinds. Transmasculine folks are now in the curious position of hoping that recent calls from Senators Ed Markey (D-MA) and Elizabeth Warren (D-MA) to deschedule testosterone will not be ignored by the very man who put those laws in place.
While Biden has made statements nominally supporting transgender folks, they have not extended to removing one of the biggest legal hurdles to transmasculine folks living lives free of fear and harassment, nor have they even acknowledged his own culpability in the situation.
For now, and seemingly for the first time, Biden has chosen to have no opinion on testosterone.
Tennessee’s decades-old aggravated prostitution statute violates the Americans with Disabilities Act, the U.S. Department of Justice announced Friday after an investigation, warning that the state could face a lawsuit if officials don’t immediately cease enforcement.
Tennessee is the only state in the United States that imposes a lifetime registration as a “violent sex offender” if convicted of engaging in sex work while living with HIV, regardless of whether the person knew they could transmit the disease.
LGBTQ and civil rights advocates have long criticized the measure as discriminatory, making it almost impossible to find housing and employment due to the restrictions for violent sex offenders. Earlier this year, the American Civil Liberties Union and the Transgender Law Center filed a lawsuit seeking to overturn the law in federal court.
The department’s findings on Friday are separate from the ongoing lawsuit.
The department is calling on the state to not only stop enforcing the law, but also remove those convicted under the statute from the sex offender registry and expunge their convictions. The agency also says Gov. Bill Lee should introduce legislation to repeal the law.
The ADA is the landmark 1990 federal law prevents discrimination against disabled people on everything from employment to parking to voting. HIV and AIDS are considered disabilities under the ADA because they substantially hinder life activities.
“Tennessee’s aggravated prostitution law is outdated, has no basis in science, discourages testing and further marginalizes people living with HIV,” said Assistant Attorney General Kristen Clarke, with the Justice Department’s Civil Rights Division, in a statement. “People living with HIV should not be treated as violent sex offenders for the rest of their lives solely because of their HIV status.”
The department’s letter was addressed specifically to Attorney General Jonathan Skrmetti, Tennessee Bureau of Investigation Director David Rausch and Shelby County District Attorney Steven Mulroy.
Shelby County, which encompasses Memphis, was named because DOJ said it’s where the law has been “enforced most frequently.”
Through a spokesperson, Mulroy noted that the allegations stem from cases handled before he took office in September 2022. Mulroy said he agrees with the Justice Department’s findings and his office is fully cooperating.
A spokesperson for the Tennessee investigation bureau said officials were reviewing the letter but had no other response to DOJ’s investigation.
A spokesperson for Skrmetti did not immediately respond to an email requesting comment.
Prostitution has long been criminalized as a misdemeanor in Tennessee. However, in 1991 — as the AIDS epidemic provoked panic and prevalent misinformation over prevention — Tennessee lawmakers enacted an aggravated prostitution statute, which was a felony and applied only to sex workers living with HIV. The law was later reclassified in 2010 as a “violent sexual offense,” requiring those convicted to face lifetime sex offender registration.
Court documents state that more than 80 people are registered for aggravated prostitution in Tennessee.
The DOJ letter details several of the struggles of those with aggravated prostitution convictions. A lifetime sex offender registration can stop people from visiting with their grandchildren, revoke job offers, and severely limit housing options. One person shared that they were barred from taking a course to get a general education diploma because children might be present in the building.
Plaintiffs who had filed a lawsuit seeking to block the aggravated prostitution law in October said the DOJ’s letter only further supports their efforts.
The lawsuit was brought by four unidentified people and OUTMemphis, a nonprofit that serves LGBTQ people.
“OUTMemphis welcomes the DOJ’s findings that, through its outdated and punitive aggravated prostitution law, Tennessee is discriminating against people living with HIV,” said Molly Quinn, executive director, OUTMemphis, in a statement. “We agree, and that’s why we are suing to get the law struck down. Whether this issue is resolved informally or in court, it is long past time to end HIV criminalization.”
The Food and Drug Administration’s first-ever approval of an at-home test for chlamydia and gonorrhea could help drive earlier detection and treatment of these sexually transmitted infections amid a ballooning epidemic in the U.S. But some sexual health advocates worry that the FDA’s proposal to begin stepping up regulation of over-the-counter self-testing of STIs could backfire.
The need for new tools to combat these infections is dire.
Diagnoses of gonorrhea, chlamydia and syphilis have soared in the past two decades. Public health experts argue that this is at least partially driven by woeful long-term flat funding of the Centers for Disease Control and Prevention’s budget to fight the spread of STIs during this period.
Some public health officials and advocates expect that greater FDA oversight will help legitimize home STI testing, making it easier to get insurance coverage and actually expanding its use.
Other home tests for these three bacterial STIs are already available over the counter. But the FDA, which has not previously sought to enforce regulation or require that their manufacturers apply for formal approval, cannot vouch for their accuracy.
A consortium of LGBTQ sexual health advocates has objected to a recent FDA policy proposal that, if enacted, would require the companies already offering at-home medical tests, including for STIs, obtain regulatory approval. A central worry is that the expense of meeting the FDA’s demands could drive some companies out of the STI self-testing market and otherwise drive up the cost of the tests.
There are also concerns that the newly approved test does not cover syphilis and is not well suited to address gay and bisexual men’s needs.
The test kit, called Simple 2, does not screen for syphilis, which typically requires at least a finger-prick blood sample. There were at least 177,000 syphilis cases in 2021, a 74% increase since 2017, according to the CDC. Most concerningly, CDC data shows that rates of syphilis in newborns, which can be fatal, rose more than tenfold in the past decade.
Dr. Boghuma Titanji, an infectious disease specialist at Emory University, said that the inconvenience of having to go into a clinic was a major barrier to getting at-risk people tested for STIs.
“Just remove that requirement, that will make the access better for a lot of patients,” she said.
Dr. Leandro Mena, director of the Division of STD Prevention at the Centers for Disease Control and Prevention, believes the new at-home test’s approval will indeed increase testing for gonorrhea and chlamydia.
Self-testing, he said, provides “a tremendous opportunity to empower people to control when, where and how they get tested, and how they learn about their test result, so they can get appropriate treatment for these STIs.”
Chlamydia and gonorrhea are the most common STIs in the U.S., diagnosed in 1.6 million and 710,000 people respectively in 2021, according to the CDC. They can often be asymptomatic and are easily cured with antibiotics. However, if left untreated, the infections can lead to infertility and can be especially harmful to women, leading, for example, to pelvic inflammatory disease. They spread disproportionately among adolescents and young adults, gay and bi men, and people of color.
Will FDA oversight help or hinder the STI fight?
On Nov. 15, the FDA granted marketing authorization for adults to use the over-the-counter Simple 2 Test for gonorrhea and chlamydia, from the home-testing company LetsGetChecked. The test kit, currently sold for $99 through the company’s website, can be activated online, where the consumer fills out a health questionnaire before shipping in samples to a laboratory.
If the results are positive, the company would then put the individual in contact with a physician.
Previously, HIV was the only other sexually transmitted infection to have an FDA-approved at-home test.
Other at-home STI tests are available through telemedicine companies and major pharmacy chains. However, these tests exist in a legal gray zone. Because they’re based on samples that are not taken in a lab, they don’t qualify for an exemption from requiring FDA approval that the agency grants to so-calledlaboratory-developed tests.
The FDA has generally not sought to exert control over home-based tests. However, on Sept. 29, the agency opened a two-month public comment period on a proposed new plan to require companies offering medical self-testing kits for any purpose to seek formal marketing authorization for their products. The FDA’s move followed reports of faulty self-tests that led to undertreatment or improper treatment for heart disease and cancer.
The goal, according to the FDA, is to “ensure the safety and effectiveness of these tests.”
In response, a group that includes sexual health advocates and owners of gay dating apps that provide free at-home HIV and STI testing, began circulating a petition that calls for the FDA to exempt such public health programs from the proposed new demands. Gaining approval for existing STI tests, the petition states, would involve a “time-consuming and expensive process.”
“Many public health leaders are concerned that new FDA regulations will create additional barriers to public health testing,” said Jen Hecht, director of the consortium Building Healthy Online Communities.
Dr. Matthew Golden, who leads the HIV and STI control program at Seattle’s public health department, said that the FDA is playing catch-up in an effort to enforce regulation of an industry that has grown fast since Covid.
“At some level, the horse has left the barn,” said Golden, noting that self-testing kits have been widely used for years. However, he said that for “some of those tests, how well they perform is not well known. So cleaning this up makes sense.”
A source familiar with FDA policies and practices told NBC News that if the agency decides to demand that self-testing companies obtain regulatory approval, it would not likely interrupt the availability of existing medical self-tests during the application process.
That said, it is likely that once a critical mass of self-testing companies obtained or otherwise sought approval, the agency would go after any laggards.
Gay men’s needs are left out — for now
The Simple 2 Test is effectively geared only toward STI exposures from vaginal intercourse.
The kit can process a urine sample and a swab of the vaginal area. Chlamydia and gonorrhea infections, however, can be localized in the throat, urogenital area or rectum. A urine sample can detect urogenital infections in men and women. For people who may have otherwise been exposed through oral or anal sex, oral and rectal swabs would also be needed.
David Harvey, executive director of the National Coalition of STD Directors, said that public health experts “expect and need” the FDA ultimately to approve at-home tests for syphilis and for oral and rectal gonorrhea and chlamydia infections, “so we’re also reaching others who are at high risk, including gay men.”
The CDC’s Mena said he hoped that the agency and the FDA will confer with LetsGetChecked or other testing companies about pushing for additional approvals.
The FDA’s authorization for the Simple 2 Test was based on data indicating that consumers could successfully use the home tests, understand the results and then take any necessary subsequent action.
It’s unclear whether the test will be available outside LetsGetChecked website or whether $99 kit will be covered by insurance. The company didn’t respond to requests for comment.
Tristan Schukraft, CEO of MISTR, a telehealth company that provides the PrEP HIV prevention pill, is supportive of greater FDA oversight of home tests, but expressed concern that tighter regulation could increase the cost of testing.
“Labs are going to be required to spend additional money and resources on studies, quality systems, reagents and software systems,” Schukraft said.
In addition, MISTR requires that PrEP recipients undergo testing every three months for chlamydia, gonorrhea and syphilis. At least 85% of MISTR customers on PrEP opt for at-home testing. The company advises people who test positive — about 13.5% of the kits detect at least one STI — to seek medical care and provides assistance in connecting people to care for those who need it.
Schukraft suggested that greater regulation could lead companies to pull such tests from the market.
If so, he said, “the FDA would be doing harm to public health.”
As Republican-led legislatures have limited or banned access to gender-affirming care for trans people across the country, states like New Mexico are witnessing a large influx of “gender refugees” seeking healthcare.
Over the past two-plus years, nearly two dozen states have instituted limits or bans on gender-affirming health care for trans youth and adults. While trans people in red states seek out alternative sources of care and places to live, larger states and metropolitan areas like San Francisco and New York can prove prohibitively expensive.
So smaller states like New Mexico, Minnesota, Colorado, Vermont, and Washington, with prohibitions on restricting gender-affirming health care and a lower cost of living, are attracting a crush of trans patients seeking care.
They’re being met with waiting lists.
“I feel really excited and proud to be here in New Mexico, where it’s such a strong stance and such a strong refuge state,” Molly McClain, a family medicine physician and medical director of the Deseo clinic, which serves transgender youth at the University of New Mexico Hospital, told CBS News. “And I also don’t think that that translates to having a lot more care available.”
The strain is affecting new patients and longtime New Mexico residents, as well.
“With the influx of gender refugees, wait times have increased to the point that my doctor and I have planned on bi-yearly exams,” said Felix Wallace, a 30-year-old trans man and longtime resident.
Anne Withrow, a 73-year-old trans woman and Albuquerque resident for over 50 years, sought care from a new provider at the University of New Mexico after her doctor retired.
“They said, ‘We have a waiting list.’ A year later they still had a waiting list.”
A year after that, Withrow managed to get care from a local community-based health center.
As of October, UNM’s Truman Health Services clinic still wasn’t taking new patients.
At the Transgender Resource Center of New Mexico, T. Michael Trimm says the center used to field two or three calls a month from people out-of-state considering a move.
“It has steadily increased to a pace of one or two a week,” he said.
“We’ve had folks from as far away as Florida and Kentucky and West Virginia,” as well as families in Texas “looking to commute here for care, which is a whole other can of worms, trying to access care that’s legal here, but illegal where they live.”
In New Mexico, the problem is compounded by a physician shortage.
A 2022 report revealed New Mexico lost a staggering 30% of its physicians in the previous four years. The state is on track to have the second-largest physician shortage in the country by 2030, with the oldest physician workforce.
Despite the obstacles, Trimm says “trans folks can be very resilient.”
While a waitlist isn’t ideal, he says it’s easier to endure “than the idea that you maybe could never get the care.”
Last September, Riley headed to their clinic at Vanderbilt University Medical Center, which was usually brimming with chatter about the day’s research and patient needs.
But that fall morning, Vanderbilt was thrown into chaos, and the clinic for gender-affirming surgeries, which serviced both trans youth and adults, had been shut down for the day. The health care worker, who is using a pseudonym in fear of retaliation from their employer, said the atmosphere among their colleagues in the trans health clinic was a mix of “fear and concern.”
Riley’s clinic remained open, and their colleagues debated whether they were safe at work or should go home. Riley said local police were lined up outside the medical center’s doors, serving as extra security for employees.
All day people whispered about the social media posts by right-wing blogger Matt Walsh, which had gone viral the day before for claiming that doctors at Vanderbilt’s transgender health clinic “castrate” and “sterilize” children.
At the time, Riley hadn’t heard of Walsh. They didn’t have social media and rarely watched the news.
But over the next year, Riley would witness firsthand — again and again — how misinformation and right-wing attacks on the transgender health clinic severely restricted the kinds of care they could provide at Vanderbilt. In those months,trans Tennesseans have felt more intimidated and desperate than ever, as they have been forced to decide whether to pack up their lives to find a place where they can exist without the fear of the government, or right-wing provocateurs, meddling in their private medical information.
One of the first changes Riley saw was Vanderbilt moving the stand-alone transgender health clinic inside the university’s main campus in Nashville, Tennessee. The clinic also adopted new security measures, including an armed guard behind the desk, and required patients and providers to be buzzed inside.
Riley said the medical center has even canceled appointments for certain surgeries for cisgender youth that currently do not fall into the category of gender-affirmation but that critics could see as “pathways to gender affirmation.”
By the end of September 2022, Tennessee’s attorney general, John Skrmetti, said his office had opened an investigation into Vanderbilt’s transgender health clinic. Over the next few months, Skrmetti broadened the scope, first requesting specific patient medical records, and then information on Vanderbilt employees and volunteers at the transgender health clinic. The following spring, Republican Gov. Bill Lee signed a ban on gender-affirming care for transgender children, effectively suspending all operations at VUMC’s pediatric transgender clinic.
Riley said they were one of more than a dozen clinicians who were told by Skrmetti’s office that their emails could be subpoenaed as part of the investigation.
“It feels like a witch hunt,” Riley told HuffPost. “What are you going to find in my emails? Obviously, there’s not a conspiracy here.”
‘That Is Why I Am Working With Matt Walsh’
In September 2022, Walsh, a prominent Nashville-based right-wing talk show host and blogger, accused Vanderbilt University Medical Center’s transgender health clinic of only existing to turn a profit. He also claimed that Vanderbilt doctors “castrate, sterilize, and mutilate minors.”
In a series of tweets, Walsh argued that the clinic was drugging and sterilizing children, and used language that LGBTQ+ advocates and Vanderbilt employees say grossly distorted the reality of pediatric transgender care. Walsh posted a video of one Vanderbilt doctor ― Dr. Shayne Taylor, who founded the clinic in 2018 ― discussing how gender-affirming surgeries, like double mastectomies and genital surgeries, could bring in “a lot of money” for the medical center. (In this video, Taylor, who did not respond to HuffPost’s request for comment, was mostly referencing surgeries for trans adults, as Vanderbilt never performed genital surgeries for minors.)
In another video Walsh posted, a different doctor cautions that employees who don’t want to treat transgender patients on the grounds of religious objections “probably shouldn’t work at Vanderbilt.” At the end of the thread, Walsh wrote that the clinic’s peer support group, Trans Buddy Program, was in fact a “gang of trans activists” acting as “surveillance in order to force compliance.”
Walsh tweeted later that evening that his “report” was just the beginning. “We are not going to let up,” he wrote. “We will shut this down.”
The next day, Vanderbilt released a statement refuting Walsh’s claims. “Vanderbilt University Medical Center is now the subject of social media posts and a video that misrepresent facts about the care the Medical Center provides to transgender patients,” the statement read. “VUMC began its Transgender Health Clinic because transgender individuals are a high-risk population for mental and physical health issues and have been consistently underserved by the U.S. health system.”
Walsh did not respond to a detailed list of questions for this story.
Even when gender-affirming medical care for minors was legal in Tennessee, the first step was still typically social transition, such as a change in name, pronouns, dress or hairstyle. Once a child hit puberty, their families might begin the long process of consulting with behavioral health specialists, endocrinologists and primary care doctors about taking puberty blockers ― medication to temporarily pause the effects of puberty ― while weighing whether hormone replacement therapy might ease a child’s gender dysphoria later in their teens.
Puberty blockers, which stop the body from making sex hormones, help slow unwanted secondary sex characteristics. They do not, as Walsh suggested, “sterilize” or “castrate” children, though the medication could pose some risks to fertility if they are administered too early in puberty. Studies show the effects are largely reversible, and the World Professional Association of Transgender Health recommends that providers talk with patients and their families about fertility preservation before starting medication.
In the years since VUMC began providing gender-affirming care for transgender youth and adults, it grew into a holistic network of care, not only involving health care providers, but also spiritual care from a staff chaplain, weekly support groups, and insurance specialists, according to a panel of VUMC practitioners at an LGBTQ+ health equity conference this fall.
VUMC performed fewer than a dozen top surgeries, or double mastectomies, each year for transmasculine patients in their late teens, according to Riley. Such surgeries require patients to undergo months of therapy beforehand, and a study published this summer showed that top surgery patients had little to no regrets decades after the operation. Both Riley and a VUMC executive, C. Wright Pinson, said that the hospital never performed “genital procedures” on minors.
But Walsh’s claims caught the eye of Republicans in Tennessee, which, with its Republican-controlled legislature, had become a paragon of a one-party state.
Hours after the tweets, Lee called for a “thorough investigation” into VUMC, and Skrmetti vowed to use the “full scope of his authority” to ensure the medical center was complying with state law.
The investigation appears to have started as early as the following morning, according to emails from Republican state Sen. Jack Johson, which HuffPost obtained through a public records request. “The Governor has already opened an investigation into Vanderbilt and I will be filing legislation to prohibit this when we come back into Session in January,” Johnson wrote to one supporter on Sept. 21, the morning after Walsh’s tweets. (The governor’s office told The Associated Press that day that it had passed along concerns about VUMC to the attorney general. Lee’s office recently told HuffPost over email that the attorney general has the “statutory authority” to open an investigation.)
The following day, Johnson responded to emails from supporters who were shocked by Walsh’s allegations, reassuring them that he was on the case — and had help.
“I absolutely agree that these surgeries should not be allowed on children,” Johnson wrote to one. “That is why I am working with Matt Walsh to introduce legislation in our upcoming legislative session to ban these transgender surgeries on children in Tennessee.”
Skrmetti’s office has said it began its probe in September 2022 after receiving a report about a Vanderbilt doctor who “publicly described her manipulation of medical billing codes to evade coverage limitations on gender-related treatment,” which raised concerns about possible fraud in the state’s Medicaid plan, TennCare. (The plan specifically excludes “sex change or transformation surgery.”)
In August 2023, a reporter with Nashville’s News Channel 5 interviewed Skrmetti. The segment showed portions of the video that Skrmetti says instigated the report: In it, Taylor discussed how she supports patients whose insurance plans don’t cover transgender health care, including saying she might write that a patient has a hormonal disorder for billing purposes so that she can order lab work for patients.
Skrmetti, in the interview, said it was “very easy” to initiate the investigation because his office was “already aware of the potential billing issues there.” He acknowledged that the probe into medical records is “probably terrifying” for patients but said there is “no political exception to the fraud laws.”
When reached for comment, Skrmetti’s office referred HuffPost to the interview with News Channel 5 and did not respond to other questions for this story.
As the investigation went on, Skrmetti requested the private medical records of more than 150 Vanderbilt patients who used TennCare. John Howser, a Vanderbilt spokesperson, said the clinic was “compelled” to produce copies of the records, while also complying with state and federal law including HIPAA. However, many LGBTQ+ and privacy advocates across the state and country signaled they were upset that VUMC didn’t fight harder to prevent turning over patient information in the investigation.
Riley said they were “flabbergasted” to learn about the attorney general’s inquiry into the center’s billing process. “There’s so many levels of oversight and protection from that kind of false billing,” they said. “It doesn’t pass the test of reason. Providers don’t do the billing. There’s a whole department of people that review the documentation and the code.”
Patients were not told until June of this year that their records had been turned over to the attorney general. Skrmetti’s office had said it kept its “run-of-the-mill” investigation private in an attempt to avoid a “media circus” — even as it continued to broaden the scope. The attorney general requested additional patient and employee data, including the names of patients who had been referred to VUMC’s trans clinic but did not seek treatment there; information on insurance claims to TennCare; employee tax forms and emails about gender-affirming care, as well as employees’ resumes and employment contracts; and information about the clinic’s Trans Buddy volunteers.
Skrmetti’s investigation and Vanderbilt’s release of records have been criticized as an egregious overstep, and the latest ― and largest ― use of data requests by a state to undermine access to gender-affirming care.
“Trust between patients and their doctors is essential to quality care, and we regret any concern this may have caused for our patients,” Howser said in a statement to HuffPost.
In the past year, as Republican-led states have increasingly passed anti-trans legislation, GOP officials nationwide have leveraged data requests about transgender residents as one of their many tools to restrict access to medical care. In Missouri, the attorney general requested and failed to obtain medical records on trans youth, while in Florida, Gov. Ron DeSantis probed state universities for data on how many students sought out gender-affirming care on campus clinics. More recently, 19 Republican attorneys general ― including Skrmetti ― signed a letter pushing back against a federal rule that would shield states from requesting data on patients seeking abortion out of state.
Many trans health advocates inside and outside the state said Walsh’s posts about Vanderbilt not only seemed to provide pretext for the probe and ban on gender-affirming care, but that his inflammatory language and framing took the doctors’ words out of context and grossly mischaracterized the kinds of care that minors were receiving at the clinic.
“The biggest thing I’ve seen is just the sheer amount of terror of families of trans youth. People are really terrified that the state is going to either try to take away their children from them or put them on some kind of watch list or try to invade their privacy. There’s just a lot of fear in Tennessee right now with families,” Lucas Cameron-Vaughn, a staff attorney at the ACLU of Tennessee, told HuffPost in July.
Cameron-Vaughn is one of the attorneys representing the families of trans kids in L.W. v. Skrmetti, the American Civil Liberties Union’s ongoing lawsuit against the state’s ban on gender-affirming care for transgender youth. The ban was recently upheld by a federal appeals court ruling.
“It may sound extreme to you when I say that we’re living in a totalitarian state,” Democratic state Sen. Heidi Campbell told HuffPost. “Before I became a state senator I don’t think those words would have come out of my mouth. But it’s really just the truth. There are no checks and balances in this government anymore. We’re seeing that with Skrmetti, who is hired by us to protect the people who live in this state, and is actively attacking our own citizens.”
‘State-Sponsored Intimidation’
On Sept. 21, 2022, just one day after Walsh’s initial “report” about VUMC, he tweeted that he had met with Johnson and Republican state Rep. William Lamberth to work on a bill to end gender-affirming care for youth. A few weeks later, ahead of the state’s midterm election on Nov. 8, Lamberth penned an opinion piece promising he would “partner” with Walsh to halt that care for minors if he were reelected to the House.
Cameron-Vaughn wasn’t surprised that Walsh’s posts lined up neatly ahead of the state’s election. “It seems like this sort of campaign against Vanderbilt was designed to scandalize Vanderbilt University Medical Center’s gender clinic by creating a deliberately false narrative right before the election,” he said.
Lamberth and Johnson both won their bids for reelection, and filed identical bills to ban care for minors months before the start of the 2023 legislative session. In February, as the bill passed swiftly through committee meetings, Walsh attended a House meeting to give an expert testimony.
State Rep. John Ray Clemmons, a Democrat who represents Nashville, was one of few legislators to question Walsh’s expertise and knowledge of best practices for transgender youth during a committee meeting on health.
“What qualifies me is that I am a human being with a brain and common sense and a soul, and therefore I think it’s a really bad idea to chemically castrate children,” Walsh said during questioning.
“You don’t use [your research] to get clicks on your publication?” Clemmons asked.
When the bill passed swiftly through each chamber of Tennessee’s government, it was clear to Clemmons that Walsh was something new. He was the gasoline reigniting an already burning fire in Tennessee. Republicans had long been trying to pass various bans on gender-affirming care, but had been largely unsuccessful. In 2021, Tennessee succeeded in barring doctors from prescribing hormone therapy for prepubescent minors — which in reality, advocates say, was not even happening in the state.
But this opened the door for Lamberth and Johnson to go further. Their legislation allows the state to ban puberty blockers, hormone therapy and gender-affirming surgeries for all transgender minors. Youth who are already receiving care will have to terminate it by March of next year, and providers have already begun weaning adolescents off hormones.
Walsh’s voice had eclipsed the dozens of opponents to the bills ― including transgender youth and their parents, LGBTQ+ advocates, and clinicians ― who showed up each week at the statehouse to share their stories about how access to gender-affirming care was very often the buffer between life and death.
Clemmons said he watched with horror as Walsh and his media outlet, the Daily Wire, helped steer conversations among some of his colleagues.
“Obviously the attorney general in this state is taking marching orders from him, which is embarrassing considering he’s not even elected,” Clemmons told HuffPost, referring to Walsh. “This is a new brand of extremism that’s very dangerous, that openly admits to wanting to burn books on the House floor, that openly admits to wanting to limit people’s rights. It’s scary.”
“This is state-sponsored intimidation and that’s never played out well in history,” he added.
The attorney general’s office declined to comment on its relationship with Walsh.
Lee, the governor, signed the ban into law at the beginning of March.
“This kind of bill had been filed in previous years and did not pass because there were divisions among Republicans on intervening in medical decisions. But there was an almost complete lockstep unanimity that they were going to pass the bill in 2023,” said Chris Sanders, the executive director of the Tennessee Equality Project.
“So Mr. Walsh is the first mover on this in a lot of ways in terms of getting a consensus built in the Republican caucus. He is not the first to think of it, but he’s partly responsible for jelling the consensus in Tennessee.”
By the end of the session in April, Tennessee had also become the first state to pass a ban on drag performances, in addition to enacting laws that defined sex as a person’s “immutable biological sex,” and allowed teachers to misgender students.
Since 2015, Tennessee has enacted 19 anti-LGBTQ+ laws, more than any other state in the country.
‘An Attempted Hostile Takeover’
This all might not have been possible if Walsh’s workplace hadn’t been given a royal welcome to the Volunteer State.
The Daily Wire, a one-stop-shop of conservative entertainment and merch — including original documentaries, TV shows, children’s programming and “woke free” razor blades ― has been likened to the right’s answer to Hollywood with a roster of conservative hosts including Walsh, Candace Owens and Jordan Peterson.
The company, which was co-founded by columnist Ben Shapiro, relocated its headquarters from Los Angeles to Nashville in 2020. The next year, Tennessee state lawmakers passed a resolution to embrace Shapiro and his “truth seekers,” and celebrate their move out of “liberal California.”
“We congratulate Ben Shapiro and his associates at The Daily Wire on their relocation to Tennessee and extend to them our best wishes for continued success in discovering and disseminating the truth,” the resolution stated.
Campbell is highly critical of how her colleagues rolled out the welcome mat for the conservative company. “This is an attempted hostile takeover of Nashville because they really want Nashville to be their first right-wing big city,” she said.
By the time Walsh moved his family to Nashville, he was already practiced in “exposing” the ills of same-sex marriage and laws that protected transgender Americans’ rights to use the bathroom that aligns with their gender.
“Millions of Americans have lost their grip on reality,” he wrote in a 2014 blog post arguing that trans people don’t exist. “This is the real crisis, and it’s far more urgent than most of what they’re talking about on the news right now.”
In the past few years, however, Walsh has turned toward a “just asking questions”-style attack on trans people. He built up mainstream notoriety and a career of lecturing at colleges after the release of his 2022 documentary, “What is A Woman,” which also sows doubt about the existence of transgender people. A self-described “theocratic fascist,” Walsh has also argued that trans people are “groomers” and part of a cult, and made posts mocking immigrants and Black people.
And last August, Walsh responded after the right-wing account LibsofTikTok posted a barrage of false claims about the care Boston Children’s Hospital provides. He called on his followers for “an organized effort to fight back against the drugging and mutilating of children.” Then the hospital, which is the country’s first pediatric transgender health program, received twoseparatebomb threats. Walsh brushed off the threats as a “leftist hoax.”
Tennessee Republicans have echoed similar anti-trans rhetoric.
At the end of 2022, the Tennessee Republican Caucus sent out a survey, asking constituents for their opinions about a number of issues including abortion and parental rights in schools. In a section called “protecting children,” the survey asks conservatives if they favor policies preventing “minors from cutting off healthy body parts in order to change their gender identity.” There weren’t any questions about guns or firearm reform in the survey, even though the Tennessee Department of Health found that the leading cause of death for children in the state was homicide, 86% of which were due to gun violence.
Late last October, Nashvillians had a glimpse of what Walsh’s version of the Music City might look like when he held his “Rally to End Child Mutilation” at the state Capitol, which garnered around 1,500 protesters, including some Proud Boys.
There was Walsh, the bespectacled and bearded 37-year-old, standing on stage alongside Johnson and Lamberth, as well as other conservative figures including Sen. Marsha Blackburn (R-Tenn.) and former Rep. Tulsi Gabbard (Hawaii), who announced that she was leaving the Democratic Party last year. Other right-wing media stars, including Chloe Cole, an 18-year-old detransitioner who has testified across the country in support of bans on transition care for minors, also took the stage to speak.
“We are all here today because of this information that Matt brought forward and showed what was taking place just down the street right here in Nashville, and showing how the radical left is trying to put their woke agenda on every single family in this country,” Blackburn told the crowd.
State Sen. Janice Bowling (R) was also present, passing out fliers with what she called “graphic” photos of genital reconstruction surgeries some transgender people may choose to undergo. After the event, she wrote to Johnson that many of the rally’s attendees didn’t know “about the assaults these surgeries are on the bodies of these children,” according to emails obtained by HuffPost. (Two Vanderbilt employees have confirmed to HuffPost that the center never performed genital surgeries on children, as is standard among clinicians of trans care.)
“Upon looking at the photos, their resolve to ‘stay the course in our opposition’ was magnified,” Bowling wrote. “A picture is truly worth a thousand words.”
‘Misinformation Is Like A Snake’
Patients were shocked to find out that their personal medical information had been shared with the attorney general — and some experienced emotional whiplash when they learned they might have been misinformed about their records being turned over. One family of a trans teen who spoke to HuffPost was first notified in June that Vanderbilt had turned over the teen’s records; two months later, the medical center told the family the teen’s records weren’t among those given to Skrmetti.
By then, the family, which requested to remain anonymous due to concerns for their safety, had already driven hundreds of miles to North Carolina to make sure their child could continue hormone therapy.
“We depend on our care providers to be honest with us,” the mother told HuffPost. “They have precious lives in their hands. I don’t know whether to believe this or not.”
In early September this year, a spokesperson at Vanderbilt confirmed that not all of the 150 records that were originally requested by Skrmetti were shared with his office.
“We have since confirmed that records for only 82 of these patients were provided to the Attorney General’s office,” said Howser, the spokesperson for VUMC, in an emailed statement to HuffPost. “After learning of this, we notified the remaining patients, whose records were requested but not provided, that their records have not been produced to the Attorney General’s office.”
Howser did not respond to further questions about why only 82 records were shared and whether the records of the remaining patients could be shared with the attorney general in the future.
“Obviously the attorney general in this state is taking marching orders from [Walsh], which is embarrassing considering he’s not even elected.”
– Democratic state Rep. John Ray Clemmons
The chaos, fear and lack of clarity surrounding the investigation has affected how VUMC operated over the last year. In addition to changes in health care offered, the medical center has removed some information about gender-affirming care from its website.
Riley said they can understand why Vanderbilt did what it could to avoid unwanted attention ― but said such changes did a disservice to those who might look to the clinic as a resource.
“Because of people like Matt Walsh, it forces that whole practice into the shadows, which has a negative impact on patients in that now they may not know about the practice because there’s no media presence about it,” Riley said.
Even with multiple statements rejecting Walsh’s claims, it has been an uphill battle to dispel the factual errors about the clinic. “Misinformation is like a snake,” Riley said. “It just moves and shifts and you can say anything you want about facts and have all the patients that have had excellent outcomes…but it doesn’t make a bit of difference to the attorney general.”
Though the clinic can no longer provide gender-affirming medical treatment for youth, Riley said they and their colleagues are “more in it than ever before” as they continue to service trans adults.
“We’re more supportive even if we’re not able to do all the things we were able to before. It kind of galvanizes a community of people to say, ‘This is wrong. We’re going to keep doing the right thing,’” they said, emphasizing that the care they provide complies within the bounds of the state’s law.
Clemmons believes that Skrmetti is “abusing his discovery powers that require no judicial oversight,” and the state’s actions are ushering in “a whole new day of invasion of privacy.” But he is hopeful that the time will come, not too far down the line, when the flames fan out.
The results of the national midterm elections showed that running on anti-LGBTQ+ rhetoric has been a losing battle for Republicans.
Still, right-wing media continues to influence voters in a way that has shifted their political ideology to further extremes ― and now politicians are trying to play catch-up.
Ari Drennen, the LGBTQ program director at Media Matters, who has spent much of her time tracking Walsh’s rise, said Walsh was able to capitalize on his boost in followers after the Boston Children’s Hospital incident and translate that into a similar push of vitriol in his home state.
“I think part of the dynamic is that many Republican politicians, including in the presidential race, are competing in a field of voters who’ve been radicalized by personalities like Matt Walsh and who are expecting to hear the same rhetoric from politicians that they’re hearing in podcasts and on YouTube,” she said. “And so I would say that it’s a case of politicians chasing Walsh’s audience more than the other way around.”
“Nashville has fought hard to be a community that welcomes everyone, and Matt Walsh has just come in and disregarded that by homogenizing the politics in the city.”
– Roberto Che Espinoza, a trans divinity scholar and Baptist clergyperson
The impact of Walsh’s rhetoric ― and Skrmetti’s ongoing investigation ― could not be any more palpable than in the stories of transgender youth and adults who are trying to find the ways to relocate to more trans-friendly states or venture on long journeys to receive medical care elsewhere.
The Tennessee family of a trans teen said their out-of-state trip was only possible with the help of a $500 grant from a nonprofit. They worry about future appointments, which will be expensive and are increasingly challenging to find. States across the South — including North Carolina, which had for many been a safe haven in the region — are banning transition care for youth.
“We’ll probably have to shuffle some things around to pay for it,” the mother said. “We will still have electricity and running water and a house to live in. There may not be as many fun or extra things going on.”
Vanderbilt is now the subject of a larger federal investigation by the Department of Human Health Services for its allegedly “unauthorized” release of medical records. And in July, two former Vanderbilt patients filed a class-action lawsuit against the medical center, alleging it had violated their privacy by turning their records to Skrmetti. The suit is ongoing but VUMC’s attorney has filed motions to ask the judge to dismiss the case.
Howser, the Vanderbilt spokesperson, declined to comment on the federal investigation or the class-action suit.
‘Weaponization Of Religion’
For some Tennesseans, the only path forward is to leave.
Roberto Che Espinoza, a trans divinity scholar and Baptist clergyperson, left the state last month after learning his medical records had been shared with the attorney general. (Espinoza, who is in his 40s, has not received an update about his records from Vanderbilt.)
Espinoza lived in Nashville for six years. He was active in the local LGBTQ+ community and often participated in social justice movements across the South, including protesting against white supremacists at the “Unite the Right” rally in Charlottesville, Virginia, in 2017.
When Espinoza saw Walsh’s posts about Vanderbilt, he went on Twitter to speak up about what he saw as a hateful distortion of Christianity.
“I was really vocal about the weaponization of religion and the dehumanization that the extreme right is peddling,” he told HuffPost. “I just tried to do my part as both a Christian minister and for my fellow trans comrades who are just trying to live their fucking lives.”
After that, Espinoza said he started getting harassed on Twitter.
“Nashville has fought hard to be a community that welcomes everyone, and Matt Walsh has just come in and disregarded that by homogenizing the politics in the city,” he said.
The week before he was set to receive gender-affirming surgery at Vanderbilt, Espinoza said the Proud Boys targeted him on Telegram. His wife told him, “I don’t know how much longer I have with you.”
Espinoza said he went from being active in Nashville’s queer religious community to feeling like a prisoner in his own home: “It was a very scary time and no way to live.”
The release of his medical records this summer was the last straw. Espinoza crowdfunded $12,000 to leave the South.
He and his wife have been building a new community in the woods. Espinoza has been enjoying grilling outside and lifting weights, and is grateful for the mundane moments of life. “I am sleeping at night and eating three meals a day,” he said. “I am able to leave my house without anxiety. It’s wonderful.”
At certain times of day, Espinoza cannot help but feel those twitches of grief. He never wanted to leave the South. He misses the “slow time.” He misses porch visits. But he would rather be “exiled” in the north than feel the weight of fear and anxiety he shouldered not too long ago.
Riley, however, is determined to remain in Tennessee, even as they worry that they and their colleagues will one day be pushed out of the state because of fear for their own personal and professional safety.
“I think the right thing to do is to stay,” they said. “If we all leave, then that’s exactly what they want. It just becomes one homogenous place.”
On November 12, Paul Glass and Charles D. Evans of Falmouth were honored with this year’s AARP Andrus Award for Community Service. It’s AARP’s most prestigious and visible state volunteer award for community service. They are the first married and Black gay couple in AARP’s history to receive the award.
AARP, formerly the American Association of Retired Persons, is one of the largest organizations in the country. With a membership of over 38 million members as of 2018, it focuses on issues affecting Americans over the age of fifty. The AARP Andrus Award for Community Service is an annual awards program developed to honor individuals whose service is a unique and valuable contribution to their community and society, reflecting AARP’s vision and mission.
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“I am beyond honored and grateful for this recognition. I feel we are not put on this earth to exist but to be of service to others and our community,” Evans told LGBTQ Nation.
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When AARP Massachusetts was looking to honor the state’s top volunteer, Glass and Evans’s names rose to the top. They have made a difference in the lives around them, sharing their knowledge, experience, talent, and skills to enrich the lives of our community. Since childhood, their indefatigable spirit to give back to their community was ingrained in them.
“Paul and Charles have channeled the many negative experiences they endured into positive, healing, and inspiring volunteer work and leadership,” wrote Barrie Atkin of Swampscott, who nominated the couple.
“Their signature work co-founding LGBTQ+ Elders of Color in 2013 in Massachusetts was innovative, unusual, and courageous. No such organization existed at that time. In collaboration with the LGBTQ+ Aging Project, they identified the need and turned the need into a reality. They didn’t just co-found the organization along with others. Their continued leadership inspires many others to be involved.”
People of color are underrepresented and underserved when it comes to aging services and resources. Paul and Charles understand the intersectional challenges and complexities of growing older as African-American gay men.
LGBTQ+ senior communities with multiple identities confront multiple challenges. Their organization, LGBTQ+ Elders of Color, fills the gap missed by Massachusetts LGBTQ+ organizations and local, state, and federal public health systems. Outreach is essential because the challenges facing Black LGBTQ+ seniors intensify with age.
According to Services and Advocacy for GLBT Elders (Sage) and the Movement Advancement Project (MAP), approximately one-third of LGBTQ+ elders live at or below 200 percent of the federal poverty level, with 40 percent being Black.
These seniors often feel more vulnerable, invisible, and isolated by retirement. Historical and ongoing discrimination has created significant lifelong challenges for this demographic: limited wealth and savings, low wages, few labor protections, housing instability, food insecurity, stigma, immigration, HIV status, and higher mortality from treatable conditions. All have contributed to a lack of well-being and a lower quality of life.
By 2050, POC seniors will comprise over 40 percent of the elderly population, and approximately 3 million seniors will identify as LGBTQ+. With this projection, specific cultural and linguistic competence training and nondiscrimination policies are needed to support a rapidly growing demographic group that has experienced a lifetime of health, educational, and economic disparities.
In 2018, Massachusetts legislators passed “An Act Relative to LGBT Awareness Training for Aging Services Providers” mandating LGBTQ+ cultural awareness training for all state-funded and licensed aging service providers within 12 months of employment.
The challenges experienced by aging LGBTQ+ people of color can only be remedied by policymakers and aggressive programs invested in expanding care and services specifically targeted to these racially, ethnically, and culturally diverse communities.
These Dapper Dans, as I fondly dubbed them, provide unique and invaluable resources for LGBTQ+ elders of color. Their impact reverberates throughout the Bay State.
“Since relocating to Massachusetts on Cape Cod in 2002 and our subsequent retirement, we have enriched our lives with stronger connections to the community through outreach and advocacy,” Glass told the audience at the award ceremony. “To some, retirement may mean the opportunity to relax and take it easy. To us, retirement has provided an opportunity to find new ways to help others.”
Without the foundation people like Paul and Charles have laid for LGBTQ+ elders of color, we wouldn’t be the vibrant, visible, and growing community that we are.