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.”
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.
n the wake of numerous discussions, panels, and speeches at PFLAG’s National Convention in Arlington, VA. last month, a notable conversation took place to illuminate the shadows cast by disinformation on trans healthcare.
The ambiance within the Crystal Ballroom at DoubleTree Crystal City was anything but cold as attendees gathered for a crucial dialogue on trans healthcare. The session, “Courageous Love in Trans Healthcare,” moderated by writer and activist Charlotte Clymer, featured a panel of health experts, including Admiral Rachel L. Levine, the assistant secretary for health in the U.S. Department of Health and Human Services, and Dr. Jesse M. Ehrenfeld, the president of the American Medical Association. The focus was clear — to dismantle the towering wall of disinformation encircling trans healthcare and foster a narrative grounded in facts and empathy.
Levine, who is trans, wasted no time in addressing one of the frequently misunderstood aspects of trans healthcare — the use of puberty blockers.
She explained, “Puberty blockers have been used for a long time. They’re used for a condition called precocious puberty or early puberty, and there was a protocol developed first in the Netherlands probably 15 to 20 years ago, where transgender children could get blockers as they continue to be with their family and to work with their therapists and their physician.” Her words emphasized the long-standing medical practice and the familial and medical support integral to the protocol.
Ehrenfeld, an out gay man whose husband and four-year-old son were also in attendance, brought to light a grave concern — a lawsuit challenging the abortion drug mifepristone that threatens to unravel the FDA’s approval process for certain medications, including puberty blockers.
He stressed, “…if this is going to go to the Supreme Court [and] if the Supreme Court decides that the FDA regulatory process for how we approve drugs and medications and biologics in this country doesn’t work or isn’t appropriate, it will cause chaos because there is a whole list of other medications, puberty blockers included, that will suddenly be challenged.” He outlined this could spawn a cascade of challenges against numerous medications, fuelled by disinformation and devoid of scientific basis.
The conversation also touched upon false narratives emerging from certain European countries re-evaluating gender-affirming care for youth.
Ehrenfeld clarified, “We evaluate our policies all the time because we want to make sure that whatever the science and evidence it is, we’re holding it up… based on what we have today, we have a clear policy that makes sense.”
He underscored the unwavering commitment to evidence-based policies amidst a swirl of misinformation.
Engaging the community emerged as a pivotal theme.
“We know that public perceptions change when you know someone who’s in the community… we can only help educate those in the community if we’re out there having those conversations,” Levine said.
Her call to action resonated as a reminder of the power of personal interactions in altering misconceptions.
According to a survey by The 19thThe 19th, 67 percent of those who know someone who is transgender support gender-affirming care for adults, while 48 percent support it for minors. However, 48 percent support gender-affirming care for those who don’t know transgender people personally, and 33 percent support it for them. For those who identify as LGBTQ+, 84 percent favor gender-affirming care for adults, and 70 percent favor it for minors.
Furthermore, the panel delved into the imperative of medical education and fostering diversity within healthcare. They advocated for an environment where all individuals, irrespective of their gender identity, are welcomed and respected.
“Diversity brings in all sorts of different experiences and different cultures and different perceptions, and it enhances any organization,” Levine said.
As the dialogue neared its conclusion, the unwavering resolve to challenge disinformation and advocate for an inclusive, evidence-based approach to trans healthcare was evident. Levine and Ehrenfeld’s potent blend of facts, empathy, and advocacy painted a hopeful picture of the road ahead.
This enlightening Saturday afternoon conversation was vital to PFLAG’s National Convention from Thursday to Sunday. On Friday, First Lady Jill Biden spoke in support of the families and friends of LGBTQ+ individuals for their unwavering advocacy for marginalized communities. Following Biden’s address, MSNBC’s Ali Velshi took the helm, moderating a panel discussion concerning book bans, sharing the stage with the president of the American Library Association, among other panelists.
Indianapolis high school senior Caston Peters had used they and them or he and him pronouns at school for three years without a problem, but they came home a few days into this school year and told their mother that the situation had changed.
Peters, 18 and nonbinary, heard from a teacher that a new state law meant they wouldn’t be able to use those pronouns, or the first name they’ve used for years, without explicit permission from a parent because the pronouns and name don’t correspond with their sex assigned at birth.
This was news to Caston’s mother, Kim Michaelis-Peters, who immediately sent teachers, a counselor and the principal an email asking them to comply with Caston’s wishes, and the school staff did. But even though her own child’s wishes are being respected, Michaelis-Peters said she has deep concerns about what Indiana’s law could mean for students whose parents might not be understanding if they learn from school officials that their child is transgender or nonbinary.
“It makes me feel like there’s going to be a child out there who’s not going to feel safe at home to tell their parents and the school’s going to rat them out for wanting to be called a different name or different pronouns,” she said.
Indiana is among at least 10 states that have enacted laws prohibiting or restricting students from using pronouns or names that don’t match their sex assigned at birth, a restriction that opponents say further marginalizes transgender and nonbinary students. Most of the laws were enacted this year and are part of a historic wave of new restrictions on transgender youth approved by Republican states.
The measures are creating fear for transgender students and sowing confusion for teachers on how to comply but still offer a welcoming environment for everyone in their classes.
“The things that are passing are so vague and so hard to understand that (teachers) don’t know what to do,” said Cheryl Greene, senior director of the Welcoming Schools Program for the Human Rights Campaign Foundation, which advocates for LGBTQ+ rights. “It just creates this ambiguity and fear with educators because it’s not clear.”
Supporters of the laws have argued that parents should have a say if children are using pronouns or names different than those assigned at birth. Republican lawmakers describe it as a parental rights issue alongside efforts to restrict how gender identity is addressed in the classroom or in library materials.
“School districts can’t shut a parent out of their child’s decision about their gender identity because the child objects or because the school believes the parent isn’t supportive enough of an immediate gender transition,” according to a brief signed by nearly two dozen Republican attorneys general and filed in a lawsuit stemming from a California school district’s policy.
Mental health experts and advocates say that requiring parental consent or notification of pronouns forcibly outs trans students, who already face a high risk of bullying and abuse.
Similar restrictions have sparked some opposition in Virginia, where Republican Gov. Glenn Youngkin unveiled new model policies over the summer that include a requirement that minors must be referred to by the names and pronouns in their official records unless a parent approves something else. Some school boards have begun to adopt policies consistent with Youngkin’s guidelines while others have balked.
Some teachers in other states are finding ways around the requirements or defying the restrictions, saying they don’t want to put their students at risk. Since the laws are being enacted in states where teachers have little job protection, few are willing to talk on the record.
Jillian Spain, who teaches social studies at a middle school in Yanceyville, North Carolina, said she’s continued to address her students by the names and pronouns they use. Spain said outing a child, which is what the law would do to transgender and nonbinary students, “is not in the job description.”
Spain said the fear of being outed just adds to the pressures students already face, especially after the COVID-19 pandemic that devastated their well-being and academics.
“I am absolutely never, ever, ever going to out a child,” Spain said. “School is supposed to be their safe place. It’s supposed to a place where they can be who they truly are.”
Teachers’ groups say educators have been given little to no guidance on how to comply with the new restrictions, including basic steps like how to get permission from parents of students who use pronouns or names not listed on their birth certificates.
Indiana, like other states, leaves the specifics up to school districts.
The state’s teachers union says Indiana’s new parental notification law, which also bars teachers from providing instruction on human sexuality to students from pre-K through the third grade, is aimed at a problem that doesn’t exist.
“We have heard concerns anecdotally about the potential impact of this law,” Indiana State Teachers Association President Keith Gambill said in a statement. “Teachers are worried that it will create confusion and additional administrative burdens in an already demanding educational environment.”
Kentucky’s new law says teachers and school staff cannot be compelled to use a student’s pronouns if they don’t “conform to the student’s biological sex.”
The law, which includes other provisions dealing with student bathroom assignment and parental consent, has prompted confusion among educators, said Chris Hartman, director of the Fairness Campaign, the state’s highest-profile LGBTQ+ advocacy group. Hartman said it allows educators to ignore students’ wishes about pronouns even if their parents have asked the district not to let it happen.
“The mental health impact on trans kids being willfully misgendered by the adults in the room is disastrous,” Hartman said. He said supportive adults are crucial to keeping transgender students from slipping into depression and considering suicide.
Jefferson County Schools, the state’s largest district with 90,000 students, struggled to comply with the new state law. After a third try, the school board in Louisville adopted a policy that includes giving students with gender dysphoria an exception for bathroom accommodations and adds potential punishment for teachers and staff who willfully and repeatedly misgender a student.
A group of parents and students in Lexington have sued over the Kentucky law. One of the families alleges a school office employee intentionally refused to use their child’s name and pronouns while speaking with them in April. The parents, who are identified by a pseudonym, decided to legally change the child’s name after that encounter, according to the lawsuit, which was filed in late September. The suit asks a judge to declare Kentucky’s new law unconstitutional.
In Indiana, Caston Peters said they think other students will suffer because of that state’s law.
“School is supposed to be a safe spot for us where we can be ourselves without having to deal with being called out, without being bullied or name-called or anything like that,” they said. “And I think for some of us being able to be called the name or pronouns that we prefer it’s something we need. And if we can’t get that at home then having it in another safe place like school — if that’s the only place we can get it — well now it’s being taken away from us.”
“Gender euphoria is defined as satisfaction or joy caused when one’s gendered experience aligns with their gender identity,” the brief notes. The term “gender euphoria” has been around since 1976 but has been studied little. The Trevor Project has drawn on its 2023 U.S. National Survey on the Mental Health of LGBTQ Young People “to examine actions other people can take to help transgender and nonbinary young people feel euphoric about their gender identity,” the brief says.
Survey participants were asked an open-ended question, “What are things that others do that make you feel happy (or euphoric) about your gender?” The Trevor Project sorted responses into four categories: affirming communication, inclusivity and belonging, appearance affirmation, and support and respect.
Under affirming communication, many respondents said they felt euphoric when people used their pronouns correctly, especially if they did so without being told. “Honestly, just calling me by the proper name and pronouns makes me so happy,” one respondent said.
Several respondents said they were happy when others used gendered terms and descriptors that aligned with their gender identity, such as “pretty” for women and “handsome” for men. Those who identify outside the gender binary, however, were pleased when others used gender-neutral terms.
In the realm of inclusivity and belonging, many “reported feeling euphoric when they were treated in ways that aligned with their gender identity,” according to the brief. This could include being compared to male or female actors or characters, “when cisgender friends ‘treat me like one of the guys and talk to me like it,’” or not being treated differently because of their gender identity, the document notes.
Appearance affirmation could include either gendered or gender-neutral compliments or provision of appropriate clothing. One respondent reported feeling happy when “my mom [bought] me boxers instead of panties.” Some said they experienced euphoria when onlookers couldn’t determine their gender; one found it affirming “when a stranger looks at me and doesn’t know what gender I am.”
Actions involving support and respect included general respect for one’s gender identity, empathy, promises of acceptance, quickly correcting mistakes about pronouns, and demonstrating open-minded curiosity. One respondent reported feeling euphoria when “someone asks about my gender identity actually wanting to try and understand.”
Going forward, the brief recommends “greater societal awareness and education to promote affirming communication”; an end to policies that marginalize trans and nonbinary youth, such as barring them from the sports teams comporting with their gender identity; “supportive environments that affirm the appearance choices of transgender and nonbinary individuals”; and open-minded communication that includes “thoughtful questions” and correct pronouns.
“These findings provide a roadmap for allies and adults to support transgender and nonbinary young people, which can foster feelings of happiness and confidence about their gender,” the brief concludes. “Using affirming language, treating young people in alignment with their gender identity, complimenting their appearance, and expressing support can help transgender and nonbinary young people feel euphoric about their gender and potentially have positive impacts on their mental health.”
As the Trans Day of Remembrance (TDoR) draws near, members of the LGBTQ+ community are preparing to memorialize those members of our community who were taken from us much too soon as a result of violence and discrimination. When we think about our deceased siblings, we experience a wide range of feelings, from sorrow to fortitude and everything in between. But there is one facet of this battle that is typically disregarded: the predicament of our transgender brothers and sisters who are currently behind bars.
When I think about TDoR, I am reminded of the hostility and violence that transgender people face on a daily basis. Incarcerated trans folks are subjected to the same political and systemic cruelty.
As a transgender woman who was recently imprisoned and housed with men, I have a unique perspective on the difficulties experienced by those who must navigate the complexity of the correctional system while also coping with the harsh reality of being transgender.
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In my time spent in prison, I was forced to adjust to an atmosphere that did not correspond with who I am. I was a trans woman who lived with guys and was attempting to navigate a world that did not acknowledge or comprehend my gender. I was trying to find my place. My everyday struggles were both physical and emotional. Every day was a challenge since there was a glaring lack of acceptance and comprehension on the part of both the inmates and the prison staff.
Transgender people are already overrepresented in the correctional system for a variety of reasons, including prejudice, a lack of access to affirming healthcare, and economic disadvantages. What’s more, the criminal justice system does not adequately accommodate their medical needs. The lack of access to qualified medical treatment and healthcare that affirms gender identity is a major cause for concern. Hormone therapy is a lifeline for many transgender people, and yet in prison, it is frequently denied or delayed.
Once individuals enter a correctional facility, they are often placed in an unwelcoming setting, which makes them even more susceptible to being physically or sexually assaulted. The horrific events that individuals go through when they are detained can be traumatic, and there is frequently neither an accessible treatment nor remedy.
Isolation from the larger LGBTQ+ community is one of the most upsetting elements of being incarcerated as a transgender person. It’s also one of the most common. It is a profound feeling of isolation, and it is challenging to articulate this loneliness to those who could provide support, empathy, and understanding. Not only are there physical walls surrounding you, but there are also emotional and psychological barriers that sometimes feel impossible to overcome.
As we observe TDoR, the experiences of our trans siblings behind bars serve as a glaring reminder of the urgent need for changes to be made in the legal system in this country. The fight for the rights of transgender people does not cease when they are brought into custody; their stories need to be heard.
It’s possible that the harsh reality of life inside a correctional facility will make the already widespread mental health issues that transgender people face even worse. Transgender people who are incarcerated may struggle with challenges like depression, anxiety, and post-traumatic stress disorder (PTSD). The trauma of incarceration is made worse when there is a lack of knowledge and empathy for the particular issues that the inmates are dealing with.
While we commemorate those who were killed as a result of violence and discrimination on TDoR, we also have a responsibility to find those who are still being mistreated and provide assistance to them. Their mental wounds are quite real, as, of course, are the physical risks they face. Their narratives are significant, their lives have value, and it is imperative that their voices be heard.
Finding the courage to advocate for myself and other transgender inmates while I was incarcerated was a lifeline for me. Finding that confidence was a challenge. The road leading to change is not an easy one, but it is one that is well worth traveling. There are groups and individuals who are working persistently to reform the criminal justice system, meet the special needs of incarcerated trans people, and provide support for those who these issues have impacted. Supporting, advocating for, and speaking out in favor of this cause is something we can all do if we work together.
It is not merely an act of sentimentality to remember imprisoned transgender folks. Rather, it is a call to action. We have the ability to work together to build a society that is more inclusive and just, one in which every trans person, regardless of their circumstances, has the opportunity to live with dignity, respect, and safety. Let us, in the spirit of TDoR, fight toward a future where the voices of our transgender siblings who are currently incarcerated will no longer be silenced, and where their lives will be cherished and safeguarded.
Let us honor those we’ve lost by making it our mission to make sure that nobody else has to experience these injustices.
There is a certain magic among trans people simply existing. Just our presence, our reluctance to conform to the constructs around gender that have been instilled in all of us since birth is powerful.
Trans people offer everyone a certain freedom, a permission to exist authentically and embrace all of the innate elements that make us human. They show us it is possible to disregard the arbitrary notion that certain traits, emotions, and expressions are “masculine” or “feminine.”
At 30, I look back to my childhood and realize that I grappled with this conflict around gender and performance well before I could contextualize my own experience as a nonbinary trans person.
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As a child of the ‘90s, I didn’t have the language to express my relationship with gender. I was friends with all of my classmates until about fifth grade. It’s that fateful age when children begin to self-actualize, notice how others are similar or different from them, and figure out how society expects them to behave with that information in mind.
The group of girls I regularly hung out with in my grade slowly ushered me out of their posse. As their interest in boys began to pique in a new and exciting way, I’m sure having me, a boy, as part of their clique was no longer conducive.
The boys in my class were similarly posturing themselves to perform for the girls, amping up this perception of needed masculinity and toughness as they prepared to enter middle school and adolescence. As essentially the only boy who shamelessly hung out with girls and embraced more “feminine” activities and attributes, it was clear I didn’t fit in with them either.
I came out as queer during my freshman year of high school. In Northern Colorado back in 2007, that was enough of a rarity. I was probably one of less than five out kids, and it put a target on my back.
Within a year, I met Melaina through my school’s gay-straight alliance. We were both 14 and attending a club-sanctioned event, an equality summit with LGBTQ+ speakers. Melaina was the first out trans person I ever met, and even before she shared her identity with me, there was something ethereal about her presence. She carried herself with this immense confidence, an authentic IDGAF attitude that most teenagers only practice as a ploy. But Melaina was the real deal.
And it makes sense. If I felt ostracized as a cis gay boy at my high school, I can’t imagine what she had to go through as an openly trans girl.
We sat next to each other on the bus, and I was in awe of Melaina’s openness and self-assurance. She was brazenly confident and knew exactly what she was about, referencing conflicts with bullies underscored by an unmatched nonchalance that I couldn’t even fathom.
The shackles of gender roles
When I talk about transness and breaking down gender roles, I posture it as being beneficial for all people. It’s the same way I talk about feminism to get men on board — like, “Hey, this is actually good for you, too.”
Humans are immensely complex. I still can’t fathom how so many people still believe that just because someone has specific anatomy or chromosomes (a sentiment that still often conveniently ignores biological sex as a spectrum), they must conform to a single, rigid expression and role. It eliminates so many aspects of what makes us human and minimizes the complexity of the human experience.
I caught onto these expectations early, as my demeanor was much more sensitive, emotional, and “feminine” while I was growing up as a boy. I was just being myself. I didn’t bury the elements that society told me were inappropriate for my gender, and fortunately, my parents didn’t push me to do so.
Since fifth grade — when those gendered differences became abundantly more clear — I’ve often found myself wondering why gender is so important in our world to begin with. What would society look like if we didn’t have these set rules that so many people at such young ages are pressured to conform to?
I especially think of the boys I was surrounded with in my childhood and adolescence who were silly and carefree in elementary school and gradually hardened as they got older.
As a queer and trans adult, I’ve only maintained friendships with two cis straight men, mostly because it’s clear that so many don’t know what to do when they find themselves interacting with me. I can see them processing how they “should” treat me — I’m not a woman, so that’s out the window; and while I may have similar physical features, I’m clearly not a man or at least don’t share that same social experience in the way I present and carry myself.
I can’t imagine how stifling this posturing has to be as someone who threw it out a long time ago. By no means am I saying that all cishet folks subconsciously consider gender so heavily in their interactions, but I witness it often in my day-to-day life.
I see that my existence, and the existence of transgender and gender-nonconforming people as a whole, is often perceived as threatening to the status quo. It’s daunting to those people who never questioned these arbitrary messages, whose identities are deeply confined to these restrictions.
Freedom for all
This conversation often makes me reflect on a statement made by nonbinary poet and activist Alok Vaid-Menon on “The Man Enough” podcast in 2021: “People have been taught to fear the very things that have the potential to set them free.”
In this years-old video that replays in my mind frequently, Vaid-Menon says, “The reason you don’t fight for me is because you’re not fighting for yourself fully. And any movement that’s trying to emancipate men from the shackles of heteropatriarchy, emancipate women from traditional gender ideology, has to have trans and nonbinary people at the forefront because we are actually the most honest. We’re tracing the root.”
I’m not saying that every person is trans or that every cis man or woman must have some sort of latent identity they have yet to address. But when we are taught so aggressively, so consistently to conform to specific expectations based on what a doctor saw between our legs shortly after we entered this world, we are no doubt inhibited from fully embracing ourselves as we are.
I intimately felt it as I tried to cram myself into the ill-fitting “male” label for the bulk of my life – until I saw how other trans and nonbinary people were happily navigating their lives beyond these constraints.
I rejoice, however, when I see the progress among cis men addressing the harms of toxic masculinity. This is evident when we see the many ways cis men today look to unlearn these harmful teachings about how they “should” act in society through workshops, classes, and therapy. I’ve seen groups explicitly made for men to be emotionally vulnerable with one another, to reimagine what modern masculinity even means. Simply allowing themselves to be emotionally mature, to communicate, and to feel is paramount to their personal concept of gender and what it means to be a man. After all, there is an inherent power in vulnerability.
While I tout these wins, it’s impossible to ignore today’s male influencers who relay the same tired, harmful messages of the past — often littered in misogyny, homophobia and transphobia — surrounding “proper” gender roles to their audience of impressionable young boys.
The fight rages on, and the transgender community remains at the forefront.
Trans people should receive support from their cis counterparts because it’s the right thing to do, because we need help from groups in power to ensure equity. But I also hope cis people understand that these constraints around gender that trans folks actively push against every day don’t benefit anyone. They rob us of humanity, authenticity, and connection with one another.
I think about the queer and trans spaces in which I regularly find myself in LA, which of course include cisgender people, too. In these spaces, we can all be whoever we are without a value judgment around our existence.
I witnessed this magic before I came out as trans myself, and while we have a mountain of obstacles to overcome, I find relief in thinking about the world taking on that same model — every person expressing themselves innately as they see fit, with gender roles and restrictions fully off the table.
The trans community has challenged tired notions, these prevailing messages around how we “should” act in society, in favor of our own pursuit of happiness.
This Trans Awareness Week, I hope that our cisgender peers and allies can look to the trans community like I once did, as role models who recognize that this fight belongs to and benefits the entire human race.
Throughout its history, many forms of gender expression have been celebrated – from the acknowledgment of a third gender to men wearing makeup to distinguish their noble and higher status in contrast with cultures like the Greeks, who were seen as less civilized.
Many have tried to argue for the rights of trans people by pointing out the more accepting attitudes of ancient Iranian civilization, an attitude that is at odds with the modern interpretation of masculinity and femininity.
And a shift did begin to take place in the 1960s thanks to one brave activist.
The mother of a movement
In the 1960s, Iran was experiencing a great shift in its attitude towards homosexuality. While conservatives condemned it, there were many gay bars and other places for young gay people to be themselves. The secret 1978 marriage of Bijan Saffari (the son of a high-ranking senator) is one example of the passive presence of homosexuality in the country.
Maryam Khatoon Molkara was born in Anzali, a deeply religious province, and grew up alongside these cultural shifts in Iran. Initially thinking she was gay, Maryam used her family’s connections with the Pahlavi family (the ruling dynasty at the time) and asked Iranian Queen Farah Diba for guidance.
The queen suggested Maryam find others like herself and create a community that could ask for protection from the state. Farah, a progressive woman unlike her husband, showed love and sympathy for gay people and was among the few members of the royal family who had good relations with them.
In 1975, Maryam traveled to London and had an eye-opening experience about trans identities. It was there she realized she wasn’t simply homosexual.
Maryam was a religious woman and began writing letters seeking religious advice from Ayatollah Ruhollah Khomeini, who was in exile in Iraq, regarding her experience of being assigned the wrong gender at birth. She mentioned her gender identity had been apparent since she was just two years old, as she used to imitate applying makeup with chalk on her face. Khomeini suggested that she live as a woman, which included dressing accordingly.
She even went as far as seeking his guidance in person when he was in Paris, but she was unable to meet with him. However, these attempts at meeting Khomeini and connecting with what became the ruling clergy saved her life.
Following the 1979 revolution and the annihilation of the leftists and liberals by the religious right, Maryam faced severe backlash due to her identity. She endured arrests, death threats, and various forms of mistreatment, including being forced to wear masculine clothing and being injected with male hormones against her will. She was ultimately forced to stay in a psychiatric institution, but thanks to her connections with religious leaders, however, she managed to secure her release. Akbar Hashemi Rafsanjani, the renowned reformist who would ultimately become president of Iran, was instrumental in helping her.
During the Iran-Iraq War, Maryam volunteered as a nurse on the front lines, and her compassionate care often led the men she treated to assume she was a woman.
Throughout this period, Maryam persisted in advocating for her right to undergo gender-affirming surgery. In 1985, she confronted Khomeini directly at his home in North Tehran, dressed in a man’s suit and carrying the Koran while seeking refuge. Security guards initially restrained and beat her until Khomeini’s brother intervened. She eventually pleaded her case before Khomeini, explaining her identity and the need for sex reassignment surgery to fulfill her religious duties.
After hearing her story and consulting with doctors, Khomeini issued a fatwa (ruling) affirming that sex reassignment surgery was not against Islamic law. Maryam then worked to implement the necessary medical procedures in Iran and assisted other transgender individuals in accessing surgeries.
In 1997, she underwent her own gender-affirming surgery in Thailand, as she was dissatisfied with the procedures available in her home country. The Iranian government supported her surgery and subsequently established government funding for surgeries for other transgender individuals.
In 2007, Maryam founded and ran the Iranian Society to Support Individuals with Gender Identity Disorder (ISIGID), the first state-approved organization advocating for transgender rights in Iran. Prior to that, she had used her own property to offer support, legal advice, and medical care to fellow transgender people, including post-op care. Despite knowing the potential risks, she continued to fight for the rights of other transgender individuals, even helping secure their release from prison.
Maryam died in 2012 in Anzali, where she was born, but her efforts transformed Iran into one of the more accepting countries for transgender people in the Middle East.
Modern Iran is not known for its love of LGBTQ+ people. With the recent attackson gay people from President Raisi, as well as the execution of a few LGBTQ+ activists, there is no denying that LGBTQ+ people are having a hard time under the Islamic Republic’s reign.
But unlike gay people, whose acts might lead them to death, transgender folks are treated as sick people who need gender reassignment surgery to live according to their true gender, just like Maryam Khatoon Molkara.
This has put Iran in an odd situation where according to the law, trans people are far more accepted than gay people. In practice, though, trans people still receive a lot of hate and discrimination. That being said, no one can go as far as publicly challenging the fact that gender reassignment is a bad thing because then they would challenge Khomeini’s words, something that could have dire consequences.
Since the late 2010s, the American culture war has found its way into Iran through the sharing of videos of Donald Trump and right-wing figures like Jordan Peterson. These anti-LGBTQ+ leaders have been attractive to Iranian youth due to their anti-Islamic and anti-Islamic Republic sentiments that seem to align well with their aim of toppling the regime.
Inevitably, the American right wing’s unique form of bigotry also found its way to Iran. Josephine Baird, a British-Swedish scholar, told LGBTQ Nation that American and European reactionaries used Iran’s acceptance of trans people for many years as evidence of their conspiratorial ideas that accepting trans people would lead to the erasure of gay people – or some sort of tyranny.
“The modern rampant transphobia has no real connection to Iran or our culture,” Becca Sanaei Kia, an Iranian scholar in the US, also told LGBTQ Nation.
There are two clashing ideas over the existence of trans people in Iran. One is the old-school religious view that trans people are sick and must be cured. The second is the Western-style secular transphobia that sees any bit of acceptance as threatening. While Khomeini and his creed were convinced of their beliefs due to religious texts and arguments, the modern transphobes rely on a distorted sense of “science” and “biology.”
LGBTQ Nation spoke with several trans people in Iran, and it’s clear that to many, the old view is more comforting because it didn’t give them a lot of visibility even if they still felt abnormal, sick, and sinful for being trans. However, some folks were more positive with regard to the new waves. They mentioned that while modern transphobia can be even more cruel and inhumane, the visibility has given rise to many who stand for LGBTQ+ rights and want to advocate for the rights of trans people.
In other words, those standing up to hate give them hope.
The National Center for Lesbian Rights is opening Transgender Awareness Weekwith the launch of #HealthcareIsCaring, a campaign aimed at transforming the narrative surrounding trans youth’s access to health care and empowering parents to support their trans children.
It comes at a time when gender-affirming care for young trans people is being banned in conservative states across the nation — 22 states at last count — and the provision of such care is sometimes being criminalized or being defined as child abuse. There has also been an effort by Republicans in Congress to ban such care nationwide.
NCLR seeks to tell what gender-affirming care and supportive parents mean for trans youth. The campaign includes a short film featuring trans young people their parents — Cameron and his mother, Myriam, from Texas; Allie and her father, Sean, from New York; and Luke and his mother, Jen, from Illinois. The film was created in collaboration with Emmy-nominated director Zen Pace and the Windy Films production agency.
“The families in our campaign, like so many other families with transgenderchildren, are proof that helping transgender youth get medically needed care can enable them to lead happy and successful lives,” NCLR Legal Director Shannon Minter said in a press release. “Still, many legislators continue to push harmful policies that prevent these young people from getting the health care they need and deserve. We’re working to take action against these bills and show the politicians behind them that transgender youth and their families are not alone.”
NCLR has successfully challenged state bans on medical care for transgender adolescents in Alabama, Florida, and Kentucky. This month, NCLR filed a petitionasking the U..S. Supreme Court to review the Sixth Circuit Court of Appeals’ decision in Doe v. Commonwealth of Kentucky reversing the victory in the Kentucky challenge. If the Supreme Court takes the case, it will be the first case involving transgender youth ever heard by the high court.
The campaign was created by public relations company Edelman and its Out Front LGBTQ+ task force. Edelman recently conducted a survey in which 74 percent of respondents said they believe parents want what’s best for their children when it comes to medical care.
“This campaign is proof of two things: the magic that happens when you bring people of every discipline together to drive meaningful change, and that having access to trans healthcare isn’t just critical to helping youth survive, but to thrive as well,” said Jordan Atlas, Edelman’s U.S. chief creative officer.
Of the film, Pace said, “This film is special to me because not only does it touch my community, but it helps put forward a much more accurate story of these families that simply doesn’t exist out there. It gives space to these parents; it’s a gift from their children.”
NCLR also has an open letter for the public to sign in support of health care for trans youth, and it offers a variety of resources explaining gender-affirming care..