Texas Attorney General Ken Paxton asked a Seattle hospital to hand over records regarding gender-affirming treatment potentially given to children from Texas, according to court filings that appear to show the Republican going beyond state borders to investigate transgender health care.
Seattle Children’s Hospital filed a lawsuit in Austin, Texas, this month asking a court to invalidate or narrow the requests from Paxton, a staunch conservative who has helped drive Republican efforts that target the rights of trans people. His office sent similar letters earlier this year to Texas hospitals.
Texas is among more than 20 states that have enacted laws restricting or banning gender-affirming medical care for transgender minors. On Friday, court records showed there been no decision yet on the Seattle hospital’s lawsuit.
The hospital argued Paxton’s office was overstepping its jurisdiction and had no authority to request the records.
“Additionally, the Demands represent an unconstitutional attempt to investigate and chill potential interstate commerce and travel for Texas residents to another state,” the lawsuit states.
Paxton’s office did not immediately respond to a phone message and email seeking comment Friday. Lawyers and spokespersons for Seattle Children’s Hospital also did not immediately respond to a phone messages and emails seeking comment.
The Seattle hospital received the request from Texas in November. The lawsuit includes a copy of the letter from Paxton’s office, which among other requests asks the hospital to produce records identifying medication given to children who live in Texas; the number of Texas children who received treatment; and documents that identify the “standard protocol or guidance” used for treatment.
The hospital argued in cannot respond to the letter under a law signed by Democratic Gov. Jay Inslee earlier this year that aims to protects minors seeking gender-affirming care in Washington.
In May, Paxton’s office sought information from Dell Children’s Hospital in Texas about its policies on puberty blockers as well as documents identifying patients it has referred for treatment or counseling. The attorney general’s office request at the time asked to examine hospital records “to determine whether any state laws have been violated or misrepresentations have been made to parents and patients.”
Those efforts began before Texas’ restrictions were signed by Republican Gov. Greg Abbott, who was the first governor to order the investigation of families of transgender minors who receive gender-affirming care.
The Texas law prevents transgender minors from accessing hormone therapies, puberty blockers and transition surgeries, even though medical experts say such surgical procedures are rarely performed on children. Children who already started the medications being banned are required to be weaned off in a “medically appropriate” manner.
Kansas City, Missouri – the home of bebop jazz and the self-proclaimed “Barbecue Capital of the World” – also has some of the most LGBTQ+-friendly laws in the country, according to the Human Rights Campaign (HRC). For the third consecutive year, HRC gave Kansas City a perfect 100 on its Municipal Equality Index, which measures LGBTQ+ equality in municipal laws, policies, and services. Residents have been working for LGBTQ+ equality for years and made major progress after the city’s LGBTQ Commission was created in 2020.
The commission’s current chair, a queer Black man named Justice Horn, was deeply involved in the fight to establish the commission and has spent much of the last year working to protect LGBTQ+ and trans rights across the region.
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Horn is young and charismatic, with an infectious laugh and a sense of humor that puts you at ease. He’s quick to praise other activists and organizers for their work and continuously highlights the role of the Kansas City community in making change possible.
Earlier this year, Kansas City became a sanctuary city for gender-affirming care, after passing a resolution saying officials would not enforce state laws targeting trans people. Horn says he wrote the resolution himself, though he couldn’t stop himself from reflecting the victory back to the community at large.
The idea came after a BIPOC and trans-led organization called Transformationsled a town hall. Horn tells LGBTQ Nation the event fueled him to look at ordinances from Minneapolis and Seattle to find the best way to protect trans and LGBTQ+ people in Kansas City. “Gender affirming care is health care access. It is life saving care access,” he explains. “It’s both health care access and not complying with state agencies to target trans folks and care providers.”
The sanctuary resolution went through the normal process and came up for a vote before the city council.
“The community came out, and I thank them for that,” Horn says. On the same day it passed, the county prosecutor issued a statement in support, saying she would “seek to protect [trans people]” rather than criminalize them. A few weeks later, the Kansas City Police Chief said in a statement that a state law restricting access to gender-affirming care was “outside the jurisdiction” of the KCPD, and they would not try to enforce it.
“I think a lot of credit comes to Councilwoman Bough or myself,” Horn says, referencing Councilwoman Andrea Bough, who introduced the resolution, “But if not for the sheer force of this community coming out – I think that’s why the dominoes fell. Because people pushed for this to happen. Without a doubt, it’s a victory. We have folks across the nation reaching out, asking how we did this.”
Leading with humility
In the last few months, Horn has spoken with officials in Lawrence, Kansas, which passed its own sanctuary ordinance over the summer; St. Louis, MO, where he says they are exploring their own sanctuary ordinance and creating a St. Louis LGBTQ+ Commission; and Springfield, MO, where they are trying to become an equality city under the Municipal Equality Index. He has also continued working with his own Kansas City government to pass a hate crimes ordinance.
“[Justice Horn] has single-handedly, I think, worked harder than anyone in City Hall on LGBTQ issues,” Merrique Jenson, a trans woman of color and activist in Kansas City, tells LGBTQ Nation. Jenson, the founder of Transformations, says she first worked with Horn approximately four years ago, and at first, she was not impressed.
“I always tell people, when I first met him, I didn’t like him,” she says. “You know, he was young and he was a go-getter. There’s a lot of younger activists who get in the work, and they just start barreling forward with what they think is needed and don’t take the time to ask what’s going on in the community or who has been doing the organizing, or what’s the history behind different issues,” she explains.
Jenson’s opinion started to change after Horn began to reveal his humility. It was after Kansas City had passed a resolution declaring it would recognize the Trans Day of Visibility for the first time, and she was slated to be the only trans activist to be honored that day. She wasn’t comfortable with that because she knew there were trans women and activists who had been doing the work for longer than she had. So she spoke to Horn about her worries.
“Justice said, ‘Yeah, I want to make sure, if this is the first time that the city is recognizing Trans Day of Visibility and trans activists, that we’re doing it right,’” she says. His openness to the conversation led her to broach another piece of the resolution.
“Somebody had actually put Justice’s name on the resolution, and I said “Hey, you know, I think you’re great. I don’t think your name has to be on this resolution recognizing trans people,” she tells us. “And Justice was like ‘Oh, yeah, I totally agree. Like, just take that off.’”
“You know, there was some humility involved,” she continues. “He leaned into it. You know, I’m a seasoned organizer. I’ve been doing this for over 20 years. I was very impressed to see him be willing to do that.”
That humility still shows up in Horn’s work today. At the start of the year, Jenson called Horn to talk about how the media was covering anti-trans legislation in Missouri. “I remember calling Justice and I was like, ‘I’m so sick of seeing, across the state, everyone who’s been interviewed, and who’s talking about trans rights, are cisgender people,’” she says. According to Jenson, Horn then started directing interview requests to trans women of color in the community. “He was de-centering himself out of those conversations,” she says.
Horn is keenly aware of the importance of letting oppressed groups speak for themselves. “I primarily identify as Black, although my dad is half Black and Indigenous. My mom is white and Polynesian,” he says. Horn looks up to his parents, who have been involved in his advocacy since the beginning. He also keeps a photo of Bayard Rustin, the Black gay civil rights activist and close ally of Martin Luther King Jr., in his office.
“I’m grateful I get to sit in so many communities because I don’t get bogged down on things,” he says. “My very existence as four ethnicities, being a young person and being LGBTQ – I fit in many groups. I like to build coalitions and consensus. I think the oppressor’s plan is to keep us divided, to keep us fighting over crumbs.”
An obligation to fight
Horn describes himself as a fighter, saying it’s a skill he learned as an NCAA wrestler. He says he is usually fighting “someone who is trying to take our rights, attack kiddos, or alienate trans people, or ban drag.” His first experience in advocacy was defending trans athletes while he was in college.
“I was actually competing in South Dakota when the state legislature – well before the current conversation – introduced a trans sports ban,” he recalls. “That was my first instance where I really made a decision. Do I just hunker down? Or do I watch out for other people who are queer, trans, who want to play sports at all levels, especially kids, and sympathize and advocate for them?” He decided to go to the state legislature and testify against the bill, and LGBTQ+ activists stopped it from passing.
The scene repeated itself this year when Horn went to the Missouri state legislature in January, where he testified, he explains, “as lead opposition expert for Missouri’s trans sports ban.” Somewhat ironically, he was honored by the Missouri House of Representatives for his work on human rights the following day. “They were fine with me being a gay man fighting for gay rights,” he laughed, “but God forbid I speak up for the trans folks and the trans kids and their right to make health care decisions.”
Horn says he fights for trans rights because he sees the parallels between the fight for trans equality and the historic fight for gay equality. “They’re using the same playbook against our trans brothers and sisters,” he explains. “They’re groomers, they shouldn’t be in our classrooms. They shouldn’t be around kids. What did they say about us [gay men] in the 90s?”
“I think as allies, especially as gay men and the LGBTQ community, we should be one of their strongest advocates. We’re part of their community.”
Horn doesn’t just direct interview requests to trans women of color. He makes sure the LGBTQ Commission is an effective tool for change. “One thing I can say is we don’t just do Pride flags around City Hall and crosswalks,” he says of the commission. “We advance policy. We expand visibility and we ensure that folks know that there are fighters for them. That they don’t ever have to suffer alone.”
Teachers who become aware that a child intends to transition will be expected to tell their parents, the UK government’s long-awaited guidance on the topic is expected to say.
After months of speculation, the government is expected to issue guidance this week on how schools should respond if a child says they plan to socially transition.
According to The Guardian, teachers in England will not have to “out” children to their families if they are simply asking questions about gender identity – the Tories’ right-wing faction apparently pushed to make this a feature of the guidance.
In the end, the government seemingly decided that children asking questions about gender at school was fine – but the guidance will draw the line at transition plans.
“Children can be very confused about these things and just want to have a conversation about it and what it all means with a trusted adult,” a government insider told The Guardian.
“That shouldn’t necessarily mean it is automatically flagged to parents.”
Tories initially wanted to ban social transition at school
The guidance is set to be issued after months of delays, leaks and backlash from both those in favour of improving trans rights and those opposed.
The government’s schools guidance first made headlines months ago when it was reported that ministers wanted to ban social transition in schools entirely.
Social transition generally refers to changing a name, pronouns or presentation – a young person who does so may dress differently, but social transition varies from person to person.
However, after months of internal wrangling – and warnings that doing so could be unlawful – ministers apparently realised that they would have to introduce new legislation to ban social transition in schools.
A Tory insider told The Guardian that women and equalities minister Kemi Badenoch “was not planning any change” to equalities legislation but that she “would generally like to go further” on the guidance.
However, they said she is not currently planning on amending legislation.
“If you open up the equalities act then lots of other groups would want to make changes and you’re also likely to have people pushing for stronger protections on trans issues than we already have,” an insider said.
In addition, the government’s guidance is expected to advise schools that they should have separate toilets and changing facilities for boys and girls.
However, another part of the guidance has been dropped – the government reportedly wanted the guidance to say that children who want to socially transition should have to see a doctor before doing so. That will no longer be a part of the guidance after the NHS said it didn’t have capacity.
A transgender woman and a gender-nonconforming gay man, both Black, were fatally shot while driving around their home city of Toledo, Ohio, in November.
A suspect was identified in their killings, but he was later found dead in Cincinnati.
Trans woman Amiri Jean Reid and gender-nonconforming man Kejuan Richardson, both 21, were shot in the head in the early evening of November 14 before crashing their vehicle, TV station WTOL reports. They were pronounced dead at a local hospital.
Toledo police classified the deaths as homicides and issued an arrest warrant for Jorenzo Phillips, 19. But he was found dead in Cincinnati on November 23, Thanksgiving Day, of a gunshot wound that was apparently self-inflicted, according to another TV station, WXIX. No information has been released regarding his motive.
Richardson, a Toledo native, worked for KFC and was a fan of Avengers movies and basketball, Pittsburgh Lesbian Correspondentsreports. Reid was known for her “ribald sense of humor,” the site notes, and her love of wordplay. “She also shared experiences of transphobia in her social media feed,” according to the site.
“Amiri’s life was cut short by senseless violence, and this narrative has become far too common for Black trans women,” Tori Cooper, director of community engagement for the Human Rights Campaign’s Transgender Justice Initiative, said in a press release. “Although our community can find solace in the Toledo police identifying her killer, the sad reality is that it won’t bring Amiri back and she won’t be able to experience the joys that come with living a long and full life. Despite the tragic ending of Amiri’s life, her spirit will live on, and we must never forget her name.”
“The killing of Black trans and gender-nonconforming people is a devastating trend that continues to rise,” Cooper added. “We’ve seen too many lives, like Kejuan’s, taken far too early, and as a Black trans woman, it makes me angry to read yet another headline of a murder within the trans community. Despite Kejuan’s life ending so tragically, it is important to remember them for all the amazing things they did while they were still here without disregarding the horrific way that they died. Kejuan and Amiri’s lives must be celebrated to remind those with hate in their hearts that the trans community will not be silenced.”
Three days after Roe v. Wade was overturned, Sam Guidogave birth to his first child. His doctors, unsure of what was still legal, didn’t prescribe misoprostol — a drug used in medication abortions — to help with contractions.
That was another blow, another way in which Guido felt he wasn’t in control of his labor. Guido hadn’t wanted to give birth in a hospital at all — he was afraid to be there. As a transmasculine and nonbinary person, they have faced the same ignorance and discrimination in medical institutions that many trans people in the United States experience. But a home birth just wasn’t an option; health insurance wouldn’t cover that or midwife care, and Guido’s apartment was too small.
Instead, Guido enlisted chosen family and friends to advocate for them in the hospital. Having other trans voices in the room ensured that they were respected by hospital staff as they brought his daughter, T, into the world. Guido asked that The 19th only use his daughter’s first initial for privacy.
“They made sure everybody who came into the room knew that I was going to be ‘Papa,’ that I was T’s ‘Papa,’ and that the language that they used surrounding myself and my body was all appropriate,” he said.
T is now 17 months old. Guido is grateful for the small wonders of parenthood, like watching T learn to blow kisses and give high-fives, becoming her own person more every day. He and his partner, Joey, both grew up with siblings, and look at them as some of the most important relationships in their lives. They want T to have that kind of special connection. So for the past six months, Guido and Joey have been trying to conceive another child. It has been a beautiful and queer process — but not without struggle.
It’s taking longer than it took with T. Seeing one negative pregnancy test after the other has made Guido feel constantly like he’s doing something wrong. While trying to conceive, Guido has gone without testosterone, which many transmasculine people take for hormone replacement therapy. Without it, he struggles to regulate his emotions as his hormones fluctuate. His period has come back, which causes him significant gender dysphoria.
Prior to his daughter’s birth, it took Guido a year and a half to find a safe and trans-affirming primary care doctor near where he lives in Janesville, Wisconsin.
(Jamie Kelter Davis for The 19th)none
Yes, they want to get pregnant. But pregnancy means being vulnerable once morewithin the medical system. Prior to T’s birth, it took Guido a year and a half to finda safe and trans-affirming primary care doctor near where he lives in Janesville, Wisconsin.
It means risking harassment from strangers when going out in public while pregnant and looking too much like a man.
It means taking on the same emotional and financial turbulence as other couples who go through fertility treatments that, for whatever reason, aren’t working.
But trying for another pregnancy has also led Guido to discover new facets of their identity. As an asexual person, it has brought them closer to their partner as they both explore what intimacy looks like while trying to conceive.
Being a pregnant transmasculine person in the United States is full of these dualities — joy and pain. The 19th interviewed two transmasculine people who were elated to become new parents, but experienced isolation and discrimination in a health care system that assumes all pregnant people are women, and by a society that still views pregnant men as abnormal.
Guido’s last pregnancy showed them that being pregnant actually felt affirming to them — not dysphoric, as it does for some other transgender men. They have often felt like they have to justify those feelings.
“I was surprised at how little dysphoria I felt when it came to pregnancy. It felt very natural to me … in a way that didn’t challenge my gender identity in any way, shape or form,” he said.
Instead, Guido grappled with feeling invisible and isolated during his first pregnancy. Outside of his close circles, he couldn’t talk about this huge part of his life with other queer or trans people. In one queer postpartum group he tried to join, other trans people were uncomfortable hearing about his pregnancy, while some queer people pointedly said that pregnancy was an experience that only women had.
He didn’t see anyone else like himself.
Guido is acutely aware of how alone being a pregnant transgender person in rural Wisconsin can feel.
(Jamie Kelter Davis for The 19th)none
“You pick up a pregnancy book, and it refers to you as ‘mama.’ You walk into pregnancy support groups, and it’s a group of cis women plus you, and everyone’s looking at you weird because you have a beard,” they said.
Those instances made Guido aware of how alone they were as a pregnant transgender person in rural Wisconsin.
In rural areas, transgender people tend to have fewer resources and face higher risks being out than trans people in urban areas, according to a 2019 report from the Movement Advancement Project (MAP). With fewer accepting employers, doctors, housing options and nearby LGBTQ+ spaces, discrimination can have a more profound effect and make hostility harder to bear.
However, regardless of where trans people live in the United States, they often face discrimination within health care. That includes being denied insurance coverage for routine sexual or reproductive screenings that are still treated as women’s health issues like Pap smears and mammograms, according to the 2015 U.S. Transgender Survey. Others must teach their medical providers about trans people in order to receive proper care. Often they are asked invasive questions.
The country’s medical system is extremely ill-equipped to care for transmasculine people, said Kellan Baker, executive director and chief learning officer of D.C.-based LGBTQ+ health care provider Whitman-Walker. It gets even more difficult for pregnant transmasculine people, especially for those who experience gender dysphoria around pregnancy, to access good care, he said.
“People assume that trans men would never want to get pregnant because of dysphoria. Or people think that testosterone is birth control, which it isn’t,” Baker said.
Health care professionals often assume that trans pregnancies don’t happen — or if they do happen, that they are so rare that it doesn’t affect their practice. This leads to doctors who don’t know how to give people proper care, Baker said.
“When people don’t have the right tools to fully understand the health care needs of trans people, it can be deadly,” Baker said.
In a 2019 study in the New England Journal of Medicine, that risk is laid clear. A 32-year-old transgender manwent to the emergency room with severe abdominal pain, only to discover several hours later — to his surprise, and to the surprise of medical staff — that he was pregnant. At that point, there was no fetal heartbeat.
The patient was correctly identified as a man when admitted to the ER. But his treatment did not correspond to his actual physiology or needs. His symptoms weren’t treated as an urgent case of abdominal pain in pregnancy and his elevated blood pressure was assumed to be hypertension.
Guido’s last pregnancy showed them that being pregnant actually felt affirming to them — not dysphoric, as it does for some other transgender men.
(Jamie Kelter Davis for The 19th)none
That same lack of knowledge among medical staff about trans people, and what kind of reproductive health care they need, also affected Kayden Coleman, a gay Black transgender man, during his first pregnancy in Philadelphia in 2013.
That ignorance among medical staff is part of why Coleman didn’t know he was pregnant for five months.He didn’t experience the same symptoms as most cisgender women would. He didn’t have breasts, so heightened tenderness was not a factor, and he didn’t have morning sickness. He only experienced fatigue, so his doctor assumed he was not pregnant.
“My rule of thumb is if you’re having sex with somebody with a penis that doesn’t detach, you can get pregnant. And you should be checking. And you cannot rely on your medical providers,” Coleman said. His own doctor at the time was a transgender man. It still didn’t occur to him that Coleman might be pregnant. “We’re kind of on our own out here,” he said.
Once he started to receive care, Coleman enjoyed taking photos of his stomach and sharing updatesas his first pregnancy progressed. He didn’t feel any gender dysphoria — he wanted to be as visible as possible.
“Ten years ago, there was no representation of Black pregnancy for trans men,” he said. “I felt like we needed more of that. So I volunteered as tribute, I guess.”
Childbirth was traumatizing because of how Coleman was treated by medical staff. He wasn’t listened to, he said. After he was induced, medical staff misgendered him and ignored his requests for a C-section until he reached what he described as a mental breakdown. After his daughter Azaelia was born,he struggled with postpartum depression, anxiety and post-traumatic stress disorder.
It wasn’t until he met a nonbinary doula through a queer Philadelphia-based Facebook group that he felt truly helped and supported. They offered a depth of knowledge and warmth that went far beyond anything Coleman was offered in a doctor’s office, explaining what he was going through in a way that made sense.
Coleman didn’t know he was pregnant for five months. He didn’t experience the same symptoms as most cisgender women would. He only experienced fatigue, so his doctor assumed he was not pregnant.
(KAYDEN COLEMAN)none
“I couldn’t be left alone with my child without having a panic attack. So she helped me through that as well,” Coleman said. She took care of Azaelia so that Coleman and his former husband could rest, and talked him through the common experience of postpartum depression.
“Just her explaining all of the aspects, like the PTSD and all of that, helped tremendously for me to be able to talk myself off the ledge when I was feeling like I wanted to unalive myself,” he said.
The Centers for Disease Control and Prevention, which only tracks how many cisgender women face the issue, says that about 1 in 8 women with a recent live birth have experienced postpartum depression. There’s minimal comparabledata on the birthing experiences of trans people, and what little research has been done has largely excluded nonbinary people and trans women and has focused on White people’s experiences.
What’s known is that trans men often experience loneliness, anxiety and isolation during pregnancy, which makes trans-inclusive health care all the more important. Transgender men and women both face limited access to gender-affirming fertility preservation services, on top of erasure, stigma and discrimination within the reproductive health care system.
And considering the grave Black maternal mortality rate in the United States — Black women are at least three times more likely to die from a pregnancy-related cause compared to White women — more can be assumed: that Black transgender men, and Black nonbinary people, face even greater dangers when accessing reproductive health care.
When Coleman found out he was pregnant with his second daughter, Jurnee, New York City was shutting down due to the coronavirus.He had to navigate medical spaces without anybody else there to advocate for him due to heightened pandemic restrictions. He couldn’t bring a doula to medical appointments like he’d planned to. Those appointments were hostile, he said.
A receptionist at a perinatal office in Brooklyn told Coleman that he wasn’t supposed to be there — it was for women only. He had referral papers from his doctor so he was able to be seen, but he said the receptionist never apologized for trying to dismiss him. He said the ultrasound technicianat that same office laterrefused to use his correct pronouns or stop calling him the mother of his child.
Coleman’s daughters pose for a family portrait at a park in Gaithersburg, Maryland, in 2020. Coleman felt that much of his treatment throughout his second pregnancy was motivated more because of racism than because of transphobia. (KAYDEN COLEMAN)none
It wasn’t a new experience for Coleman to be misgendered. But this was worse than what he had gone through before. He was stuck, COVID-19 limiting his options. He couldn’t just find a new perinatal office or a new place to get an ultrasound.
Coleman felt that much of his treatment throughout his second pregnancy — including medical personnel repeatedly asking him if he wanted an abortion even as he talked about how happy he was to have another child — was motivated more because of racism than because of transphobia.
“Them knowing I’m pregnant takes a backseat to their fear, or their microaggressions, towards Black men,” he said. “If I would have lashed out or lost my cool, now I’m the angry Black man, and who knows what could have happened.”
Those experiences robbed Coleman of moments of joy during his pregnancy that he can’t get back, he said. He remembers leaving an ultrasound appointment with Jurnee’s other dadfeeling hurt, angry and uncomfortable. And those moments kept piling on.
“As soon as you’d get one thing rectified, here’s another one. Eventually the office got it together, the ladies in there were even nice. But that was towards the end of my pregnancy,” he said. “The next move was to be in the hospital.Now I have a whole other staff that I have to deal with. And a whole other list of microaggressions that I have to deal with.”
Guido also struggled after T’s birth, experiencing a brief period of postpartum psychosis followed by depression that lasted for eight months. They started medication for their symptoms and saw a therapist weekly, feeling overwhelming guilt for not being as attentive of a parent as they wanted to be.
Their experiences with postpartum mental health issues underlined for them how vital it is for other transgender people to have access to birthing and postpartum spaces that are meant specifically for and led by trans people. Right now, even finding reproductive health care at institutions knowledgeable of trans people is difficult. And when Guido didn’t have trans-competent health care, he had to educate his own medical providers about his basic existence while trying to get help.
Guido hold his partner’s hand at their home in Wisconsin. Guido also struggled after his daughter’s birth, experiencing a brief period of postpartum psychosis followed by depression that lasted for eight months.
(Jamie Kelter Davis for The 19th)none
“My gender is intrinsically tied to this fertility journey and is a non-removable piece of it,” they said. “It’s already a very personal and difficult process currently, to conceive. I don’t really need additional factors making it harder.”
As Guido continues his journey to conceive again, he has found a new postpartum support group for queer and trans parents in Madison, roughly an hour’s drive from where he lives. The group meets every month. He joined them for the first time on a sunny, crisp Saturday in late October. The older kids — the 3- and 4-year-olds — played in the park as the adults swapped stories and ate packed lunches.
That meeting was an emotional moment for him. It was the first time he had ever interacted with another transgender parent who had gone through a pregnancy. Not only was his experience as a trans person being understood, but he wasn’t being doubted for his lack of gender dysphoria while pregnant. That was actually a shared experience between himself and the trans man that he met, who had brought his own family.
“It was just a relief to be like, ‘Oh, you get it. You’ve been there,’” he said. He’ll be back in the spring when meetings start again — when he expects to meet other trans parents like him.
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.”
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.
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.”
The nation’s largest LGBTQ rights group released its latest data on fatal attacks on transgender and gender-nonconforming people, describing an “epidemic of violence” targeting the community, especially young Black trans women.
The Human Rights Campaign found that at least 33 transgender and gender-nonconforming people have been killed in the United States since November last year. Of those deaths, 26 have been recorded so far this year, following a total of 41 recorded deaths last year. The annual report was released Monday to mark Transgender Day of Remembrance.
“The epidemic of violence against transgender and gender non-conforming people is a national embarrassment,” Human Rights Campaign President Kelley Robinson wrote in the report. “Each of these lives taken is a tragedy — the result of a society that demeans and devalues anyone who dares challenge the gender binary.”
People of color have made up the largest share of trans and gender-nonconforming victims of fatal violence since the group began tracking such data in 2013. This year, 69% of all victims were Black, and 51% were Black trans women, according to the report. Hispanic people were the second largest group of victims, making up 21% of all deaths. White people made up 9% of the deaths.
The data also showed that most of the victims were under the age of 35. In the past year, the average age of victims was 28, according to the report.
Human Rights Campaign has identified at least 335 transgender and gender-nonconforming people killed in the past decade. The past four years have been especially fatal for the community, with 171 recorded deaths. In 2021, the number of deaths recorded by the rights group in a single year peaked at 59.
The report emphasized that their numbers are likely an undercount, because “data collection is often incomplete or unreliable when it comes to violent and fatal crimes against trans and gender-nonconforming people.”
It also included a call for lawmakers to take action to address violence toward LGBTQ people by passing legislation such as the Equality Act, which would prohibit discrimination based on sexual orientation and gender identity in numerous arenas, including employment, housing and education. The bill passed a House vote in 2021 but has not seen movement in the Senate.
Human Rights Campaign declared a national state of emergency for LGBTQ people earlier this year in response to growing numbers of anti-LGBTQ bills introduced nationwide. The majority of the bills target transgender people, according to the rights group, and aim to limit their use of bathrooms, access to gender-affirming care and participation in sports.