Jules Gill-Peterson and Charlie Markbreiter join us to discuss Emily Bazelon's recent controversial New York Times Magazine cover story "The Battle Over Gender Therapy," its harmful and historically inaccurate portrayal of medical transition, and why liberals are so ready to embrace gatekeeping in trans healthcare.

Jules Gill-Peterson is an associate professor of history at Johns Hopkins University and the author of the award winning book, Histories of the Transgender Child. She is also a co-editor at the journal TSQ: Transgender Studies Quarterly, and writes the Substack, Sad Brown Girl. — [Note: Jules Gill-Peterson is now a co-host of the Death Panel, this interview was recorded before she became a co-host of the show.]

Charlie Markbreiter is the managing editor of The New Inquiry and the author of the recent piece in The New Inquiry, “‘Other Trans People Make Me Dysphoric’: Trans Assimilation and Cringe,” which is about how cringe has been weaponized by the conservative right as a form of social control. His first book, Gossip Girl Fanfic Novella, is out from Kenning Editions.

Transcript by Kendra Kline. (Kendra is currently accepting freelance transcript work — email her if you need transcripts!)

Jules Gill-Peterson 0:00

I'm one of like 3 million expert trans people who talked to Emily Bazelon, so like trust when I say I've literally explained all of this to her on the phone. I was sitting in my office, and we had a long conversation where I was like, look, you need to make some real serious decisions about how you're framing this piece, because one, you're going to make historically inaccurate and factually incorrect claims, and two, the way you're setting this up in this sort of both sides, you know, kind of framework I think is really dangerous and damaging and -- well.

Death Panel 0:39

[intro music]

Beatrice Adler-Bolton 0:57

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So for today's show, Artie, Phil and I are joined by two returning guests to talk about the fallout around a New York Times article by Emily Bazelon called, “The Battle Over Gender Therapy,” which some people in the media have described as being about "one of the most contentious issues on the planet," by which they mean it is about trans healthcare standards, social transition, and a general right to life in our society for trans people, all of which have been under increasing attack for years.

So we've asked good friends of the panel, Jules Gill-Peterson and Charlie Markbreiter, to help us talk about what is really going on here.

Our first guest, Jules Gill-Peterson, is an associate professor of history at Johns Hopkins University and the author of the award winning book, Histories of the Transgender Child. She is also a co-editor at the journal TSQ: Transgender Studies Quarterly, and writes the Substack, Sad Brown Girl.

Jules, welcome back to the Death Panel.

Jules Gill-Peterson 2:15

Thanks for having me back. And thank you to deathly liberalism for always giving me a prompt [laughter].

Beatrice Adler-Bolton 2:23

Absolutely. And our second guest today, Charlie Markbreiter, is the managing editor of The New Inquiry and the author of the recent piece in The New Inquiry, “‘Other Trans People Make Me Dysphoric’: Trans Assimilation and Cringe,” which is about how cringe has been weaponized by the conservative right as a form of social control. His first book, Gossip Girl Fanfic Novella, is out from Kenning Editions this fall.

Charlie, welcome back to the show. It's always great to have you.

Charlie Markbreiter 2:48

Hi, this is Glenn Greenwald, and welcome to Jackass. [laughter]

Beatrice Adler-Bolton 2:57

So --

Phil Rocco 2:58

Hell yeah.

Beatrice Adler-Bolton 2:59

Yeah, so as I mentioned at the top, recently, on June 15th, The New York Times Magazine published a huge cover story by Emily Bazelon, called “The Battle Over Gender Therapy,” which basically claimed to be about trying to show all sides of a big debate among clinicians on how to deal with providing gender affirming care to the "thousands of trans teenagers" who are now just banging down the door asking for new therapies, and this kind of framework of there being a growing epidemic of sort of trans-ness, in the United States. And it was a tremendous work of concern trolling in the genre of people "just asking questions" about what is framed as this kind of new epidemic of trans-ness sweeping today's youth.

So, in truth, this piece by Bazelon, for The New York Times Magazine, is a bit of a mess, and many have called it harmful, anti-trans propaganda. And that's not super surprising. A lot of bad rhetoric is being translated here as if it's a kind of discussion of nuance. Bazelon has not covered trans issues before, and this is a point that a lot of people have brought up. And I think we're gonna focus on that criticism less, but it does really show in this piece, because Bazelon uncritically quoted groups well known for gender critical rhetoric, uncritically quoted parents saying pretty horrible things about their kids, mischaracterized some of the guidelines that it was reporting on, and uncritically asked some questions, "tricky questions," that are actually better known as conservative or gender critical talking points, like: are trans teens of today different than trans adults of the past, or are trans teens new? Or their also classic issues in the kind of debate over the role of medical authority in gender affirming care, like are trans-ness and mental illness or autism mutually exclusive categories, and do people with mental illness diagnoses deserve to transition?

So it's worth mentioning because again, a major theme of the article was it was trying to show both sides of a debate over new clinician guidelines for standards of treatment. And much of the discussion redounds to a kind of ethics debate in which many people that are quoted in the article are advocating for raising the minimum age for access to gender affirming treatments to 25. So I just wanted to be clear going into the discussion that this is the context of the piece that we will be discussing, this is what the piece is actually doing. But I don't want to jump too far ahead.

First, I'd love for us to get into it from the top. Bazelon structures her piece as being around a new set of guidelines, called the Standards of Care 8, which are due to be issued by the World Professional Association for Transgender Health, which is better known as WPATH. And this is the most recent update of the standards, and this organization has been around for a while.

Jules, do you mind walking us through what these standards of care are functionally, what they're supposed to govern or do, and what the role of WPATH has been historically in transgender care, because Bazelon frames this organization as being tremendously trans-focused and says that this is about sort of setting a gold standard for care? But that's not what a lot of trans people that have spoken up about this have said, that they feel that that's the role that WPATH has played historically. And there are a lot of people who are also questioning this decision of WPATH to give this to The New York Times in the first place.

Jules Gill-Peterson 6:19

Yeah. Thank you for starting here because, you know, on the one hand, if this article has asked questions that have never just been asked before, in this way, or you know, never have questions just been asked like this before, it's really nice to actually start a conversation with answers, because one of the most absurd kind of aspects of the piece is that it presents all of these things as really, really difficult, you know? Like, wow, just these opposing interest groups, as if we didn't actually already know answers to these questions like maybe 50 or 60 years ago. So, but here's the thing is like I don't expect most people to know what WPATH is. And actually, the article's history of WPATH is incredibly shallow and incredibly biased. It just like basically implies that WPATH sprang into existence as this like benevolent medical organization. And you know, you can go -- go ask, go ask some trans people that you know what they think about WPATH.

Okay, there are lots of trans people who are a part of WPATH, and they have been historically, but this organization used to be called -- and if you want to hear the worst acronym in history, it's not WPATH, it's HBIGDA. It used to be called the [laughter] Harry Benjamin International Gender Dysphoria -- I don't know, I'm messing it up. Like who would ever call something that?

So this all goes back to the 1960s when there's this, you know, old congenial German American endocrinologist, Harry Benjamin, who's really largely responsible for the gatekeeping model of transgender health care that we have today, right? That's the model where trans healthcare is a special kind of health care that tries to not make itself available to as many people as possible, right. So the whole purpose of transgender health care is to stop as many trans people as possible from transitioning. And Harry Benjamin created the sort of standards by which we would try to do that, in the 1960s. And so those standards included heterosexuality, they included wanting to disappear into society, they included being a well behaved middle class person, they included trying to pass at all costs, right.

They included basically a kind of extreme respectability politics. And you know, as the 1960s wore into the 70s, and Benjamin was sort of a key player, this Harry Benjamin society, right, sort of was formed and became the kind of rudimentary sort of organization for clinicians. Now, it wasn't formed in the interests of trans people. It was formed because clinicians who provided hormones and surgery were generally regarded as quacks by other medical professionals. And so they just wanted to band together basically, to help lend prestige to what they were doing and to further their own institutional goals. And so over time, the HBIGDA essentially created the standards of care for transgender health care, that then morphed into WPATH which now, you know, is a fully international organization. But so basically, the history of this thing is it was designed to gatekeep and stop trans people from transitioning as much as possible. Like this is not -- these are not our, you know, friendly neighborhood collaborators and certainly there's a very complicated, long history to how trans people have tried to advocate, challenge and basically remake HBIGDA and WPATH from the inside. So I don't want to imply that like doctors, you know, have ruled by fiat, but it's really disingenuous then for this to be presented in the article as if like, well, we can trust these folks, they're doctors, right?

And so what's happening right now is the standards of care are undergoing a revision, and it's become just unbelievably politicized. But actually, as you could probably imagine from the way I've been narrating this history, it's always been incredibly politicized. However, WPATH now is really, really, really reeling from a lot of intense critiques. There is a separate organization, TPATH, that's more trans justice oriented, that has disaffiliated from WPATH. There are accusations that WPATH has essentially been sort of "infiltrated" by like Christian evangelicals and other anti trans forces that are sort of trying to, you know, turn it into a police organization from the inside. So there's a lot of turmoil going on.

And I should say, you know, I'm part of this working group at Harvard, that's made up mostly of, you know, practicing physicians, mental health clinicians, activists, and other trans advocates, including yours truly, who have been looking at this revision, in particular of the child and adolescent aspect of the standards of care, because when the draft version was released, I mean, it basically pissed off everyone, no one liked it. I mean, the far right, anti-trans people didn't like it, because it softened some requirements, but most of its requirements are just completely arbitrary and made up. They have no reference to anything tangible, as far as clinical care goes, as far as evidence based research goes, as far as listening to trans people go. But also at the same time, you know, there is this sort of -- we've been watching this creep of anti-trans discourse into trans medical settings, this kind of constant ceding the terrain discursively and politically over and over.

And so you go look at the draft proposals, and they basically included all this laundered language from anti-trans Christian and TERF groups, that they're just like incorporating in the classic liberal move. They're like, oh, our enemies are at the castle gates, let's just concede 20% of what they believe, and then I'm sure they'll stop. Call it the Andrew Sullivan approach, right. And so this is really where we are, right. And I think that Bazelon's article does an incredible disservice when it's basically like, doctors, right, they operate based on dispassionate reason, unlike trans people, right, who are incredibly hysterical and just want to transition for suspicious reasons. And that's -- basically, the article sort of implies that WPATH is just now becoming politicized, and it really sucks, because, you know, righ-wing Christian people shouldn't necessarily get to decide everything about trans people's lives, but doctors definitely should. And it's just the most nonsense both sides framing that's actually just historically and factually wrong. And I'll shut up now, because you can see how angry I am about this.

But like, I'm one of like, 3 million expert trans people who talked to Emily Bazelon. So like, trust when I say I've literally explained all of this to her on the phone. I was sitting in my office, and we had a long conversation where I was like, look, you need to make some real serious decisions about how you're framing this piece, because one, you're going to make historically inaccurate and factually incorrect claims and two, the way you're setting this up in this sort of both sides, you know, kind of framework, I think, is really dangerous and damaging. And well, we saw which version got published. So anyways, you know, airing the dirty laundry of WPATH is something I do every day as a historian, but you know, I would say the difference between how I narrate it and how Bazelon narrates it, is I have this sort of, you know, attachment to something I would call truth [laughter], and that seems to make a big difference.

Phil Rocco 13:51

It seemed like in reading the piece that the -- it was like this search for a narrative form that feels like very common in, you know, top publication outlets, which is like you're trying to like frame this debate, and there's this search for the neutral sort of mediators who are just caught in the middle of this impossible, you know, essentially amaterialized, like not -- you know, not real in like, you know, just simply just like ideational divide, and they're going to help us navigate through, through their words, which we're going to sort of treat as the tacit like voice of neutral expertise in the piece. They're going to help us like navigate through this minefield in which no one can simply agree and it's just these sort of irreconcilable ideational differences that don't actually have any sort of material bearing on people's lives. I mean, and it -- so in your description of that, Jules, it felt like the -- you know, in the truth of it and seeing the space between the truth of it and kind of the way that she wrote it, it felt very familiar in the way that contemporary reporting is just like searching for this almost like mid 20th century model of expertise as a way of dealing with the problems that your typical like Slate piece kind of like wrings its hands over.

Charlie Markbreiter 15:13

This reminded me of a This American Life episode where the premise is, do you know who the true heroes of basketball are? Referees. [laughter] And I think -- well, I mean, I fully agree with what both you and Jules are saying. I think this is a very like end of history, technocratic vibe, where part of the ideological aim is to make it seem like we've actually solved all the problems, and we just need the most sexy technocrat to just tie up the loose ends and find the perfect rules that will make everyone happy. And then we will have solved the problem.

But I -- to embarrass Jules for a sec, she wrote a piece for The New Inquiry in 2021, called “From Gender Critical to QAnon: Anti-Trans Politics and the Laundering of Conspiracy.” And I feel like in terms of genre, Jules really I feel like hits the nail on the head here in terms of describing these liberal pieces that are extremely hostile and how these sort of pundits not only are like saying things that are obviously themselves eugenicist, but are sort of dog whistling through this sort of like sock puppet army, which has no problem sending death threats, or calling trans people pedophiles. And so it's this on the one hand, this neutrality that's of course not really neutral, and also this sort of like liberal neutrality that tacitly dog whistles to people who have no trouble being illiberal, one might say.

Jules Gill-Peterson 16:51

Well, I mean, thank you, Charlie. And folks, this is what an amazing editor can do for you -- come right on a podcast and trumpet something that, you know, you helped put into print. So thank you, Charlie. I mean, I think, you know, it's exactly that, right? I mean, there's something interesting maybe to think about here about how trans medicine is one of these arenas where like the dream of the 1950s is still alive. And like in this moment, where, you know, American liberalism would rather do anything than admit it's a very happy willing dance partner with American fascism, like these are -- these are smart, false dilemmas to set up and it makes sense that, you know, in The New York Times', and New York Times Magazine's recent turn under new management towards like, we have got to, you know, go full The Guardian and constantly put out hit pieces on trans people. I mean, you can really do -- I think what Bazelon innovated to me is sort of -- and I mean this, you know, with prejudice, this is a derogatory innovation -- what she did, I think, was she showed basically how you can mobilize kind of liberal white woman sentimentality to build out a kind of false architecture that then comes to the conclusion that you are pretending that you've been hiding this whole time, right, which is like, well, what if you just do the same thing that literally every liberal journalistic piece about trans people does, which is ask this question like, hmm, well I just think it's legitimate to try to stop trans people from being trans. So how can I dress that up as a neutral, like, you know, value-free, apolitical thing that actually, the right of me to stop trans people from being trans is a real right that's being infringed on right now, right?

And so you go through this whole piece, and you basically come to find out that it's actually normal and good, and apparently best practices to try to stop trans children from being trans before giving them the most basic modicum of human dignity. But here's how you do that, right. And I think I appreciate the shout out to the, you know, the laundering piece, because I think a lot of the way that anti-trans discourse works most effectively is within a broader ecology, right. So you sort of plant the really specious eugenic, anti-trans language within a bigger ecosystem, a bigger environment where you also just leave, you know, ostensibly, contrary viewpoints just sort of hanging out, but then you snake your way through so that inevitably, at the end, you arrive back at your, you know, preconceived assumption.

But so for example, you know, in this article, we meet and talk to some of the clinicians in the Netherlands, right, this so called Dutch model, which we're told, and this is absolutely historically inaccurate, and I told Emily Bazelon this on the phone, but it's presented to us as if children transitioning was invented in the 1980s in the Netherlands. Well, folks, that is untrue. And how do I know that? Because I wrote a whole fucking book about it. And guess who read that book, supposedly? Emily Bazelon. Okay.

Charlie Markbreiter 19:51

Can I just add, in a gossipy way, that in the Twitter thread in which she announces the difficult piece that she bravely writes, she's like but if you don't believe me, you can check out some other books that are written by a trans, and one of them is this book by Jules. And I'm just like, it is deranged to me the way liberalism just like smooths any kind of cognitive dissonance, to just like a beautiful sheen that you could literally ice skate on [laughter], because she could imagine literally talking to you, having you be like, no, like, you're doing this very wrong and then being like, okay, I'm going to ignore everything Jules said, but I'm gonna cite her to make myself look really good.

Jules Gill-Peterson 19:59

Yes.

Charlie Markbreiter 20:08

I didn't mean to cut you off, but I just had to bitchily insert that. Okay, please proceed.

Jules Gill-Peterson 20:46

No, no, that's exactly it, though. It's this kind of draping -- I want to call it like draping in the trans flag, right? Like, she publishes this Twitter thread where she's like, here's my piece. And then randomly, here's all this stuff by trans people that she does not talk about in the piece with one exception. So my book, Andrea Long Chu's On Liking Women. I'm like, what are you talking about? These are like projects of trans-ness that are so absolutely condemnatory of your article, why are you just pretending that they have anything -- but this is the point, right, is I think you lodge sort of your actual politically motivated kind of attack and you couch it in this larger like, “Well, I actually talked to everyone, it just so happens that after talking to everyone and reading everything, I still sided with anti-trans side…” [sarcastic laughing]. “…And therefore I must really -- like please respect my deliberation…” right? This is the sort of emotional attachment to liberalism as process, right, as deliberation, “as I, Emily Bazelon, who is not trans, who is not in the trans struggle, who doesn't have anything on the line, really went through, you know, an emotionless reflection period, and then bravely wrote this article. So actually, what I have to say is more important than, say, multiple trans people with PhDs who have been doing research for a long time, including decades, at some point,” right.

And so in this piece, you meet this clinician in the Netherlands, okay, who's like, yeah, I started giving puberty suppression medication to kids in the 80s, right. And then Bazelon uses -- literally uses the AIDS, like the AIDS moral panic terminology of patient zero to talk about the first like trans boy that, you know, suppressed puberty.

Anyways, like, so we meet these two people, right? The kid has grown up into a man, right? And he's like, yeah, you know, I'm so glad I got to do this. I wish more kids did, right. And then the clinician is like, yeah, you know, we were so conservative when we were starting this work, we were so, so, so reluctant to give trans kids puberty suppression medication. We really were so slow. We pioneered this "watchful waiting" paradigm where you just try to be as slow as possible, don't intervene too much. Wait and see how someone is, you know, developing in adolescence, and then, you know, begrudgingly give them puberty suppression. And you know what, that probably hurt a lot of trans kids. So you literally have the clinician who invented supposedly this model being like, yeah, it's really conservative, really slow, and we harmed trans kids because of that, right? And so it's like, that's -- it's right there in the piece, right? Like that actually should have been the lead, that should have been the smoking gun, because there you have the people most involved telling you what actually happens in the clinic, and it's not good news, right?

But then I think what happens, right, is you put that in, so you can satisfy your due diligence as a journalist, so then you just drown it out by presenting a bunch of people and organizations who are explicitly dedicated to reducing the number of trans people in the world, and stopping them from transitioning, and present it all as equally on the same playing field, right, in terms of expertise and authority. And then it's like, well, whose voice ends up mattering the most towards the end, right? And so it's like, I think it's the same thing in the bizarre Twitter thread, where it's like, Hey, I read Susan Stryker and Jules Gill Peterson and Andrea Long Chu. And it's like, well, congratulations, like anyone can read those things.

But you know, in the piece itself, it just sort of goes on and on too, like just at a writerly level, it would say like, you know, as we often do in our world these days, you wake up, you feel tired and grumpy, you're gonna go make your coffee, and you're like what stupid internet article do I have to read today and spend my day thinking about, like thanks again, 2022. And so that day, it was that one. And I was sitting down and reading it as I made my morning coffee, and I was like, oh my god, this thing just keeps going on and on and on and on. And it didn't really have like a great narrative arc. Like this is not -- like I'm not being that shady, it's just like, whatever. But like it just kind of just kept going, like and here's another person who said something. And here's another group of people who said -- and I just feel like, you know, if I was reading this, like as you know, let's say John Q cis person, you know, reading public, I would be like, who are all these people? Like, I'm confused, right? Like, never mind that WPATH just shows up and like I wouldn't expect the general public to know like the tea of the history of WPATH, but it's also just like, you know, you just get this kind of onslaught of people that become sort of generic and interchangeable, that I really wouldn't blame anyone at all for not really reading that piece and being like, huh, but the actual person at the Dutch clinic was like, we hurt kids by being conservative. Wait, that's exactly the opposite of the conclusion of the piece.

Charlie Markbreiter 25:38

No Jules, I think that's actually -- I think actually asking why is the piece so long is a really interesting question, both on like an aesthetic and ideological level. Because, you know, from an editorial perspective, like part of the aim is to make pieces like a short, readable length, right? So having it be so long, right, having Emily -- allowing Emily Bazelon to write like the Infinite Jest of TERF lit [laughter] was a deliberate decision, right? So like why was that made by the editors? I don't know the answer. But I think you've provided like one answer for us, right, which is that the sort of sheer numbing length of this article allows the contradictions that Bazelon is presenting us, to be kind of again, sort of like sanded over, because there's just literally so much of it. I feel like I was watching like a Marvel movie with a 50 person ensemble cast. Like when you said, oh, you couldn't blame someone for not remembering that XYZ happened at the Dutch clinic, because there's so much else going on.

Again, I don't want to like make this sound too intentional, because obviously The New York Times kind of specializes in sloppy editing and like aesthetic mediocrity, but I just did think that that suggestion you made was really interesting. But in a way, like, again, I feel like on the one hand, these contradictions are so glaringly obvious, but on the one hand, it doesn't really matter that the contradictions are there because the function -- it's funny because again, this piece thinks of itself as being very neutral and unemotional, but actually, one function of it is an extremely emotional one, which is okay, liberals are increasingly eugenicist, have been increasingly so, you know, since COVID, how do they reconcile the fact that in this case, as in many other cases, they have the same position on childhood transition as literal fascists, right? 'Cause that might make you think, right, like you're doing something wrong, like if you're like, damn, I think like all the same thing as like the Nazis, like that's kind of weird, right? Because I'm not a Nazi. So you're like, hmm, how do I make sense of that to myself?

And I feel like one function of this piece isn't to make sense, but just to be a kind of like soothing ASMR, spiritual glow for liberals, to be like, “listen,” like “you're doing eugenics, but in just like a different way, like the vibes are just different with you. So like, don't feel bad about it. Like if your kid wants to transition, and you're going to actively block them from doing that and like make them suicidal, like you're not a bad person. You're just a concerned parent, and you are different than those bad Republicans.” And, you know, especially if you think of like who The New York Times' reader base is, it's pretty insidious. I mean, people were talking on the [Death Panel discord] server about like, saying like “yeah, my parents received this article and talked to me about it, being like, see, those things I thought about you, now they're being verified by The New York Times.”

Artie Vierkant 28:48

God.

Charlie Markbreiter 28:48

So, yeah.

Artie Vierkant 28:51

Well, I mean, I think this is why interrogating and pointing to exactly the position that this is coming from, I think it really helps to kind of like understand the piece and refute it too, right. Because I think a lot of the claims that are made in the piece in the first place and a lot of the -- even the kind of premise of oh, here's our piece where we listen to, you know, sort of all sides of the argument putatively, even like so far as to like kind of -- there's a beautiful moment in the piece where Bazelon kind of posts her own Ls, basically, by -- she quotes like some anti-trans parent group saying that like, oh, the internet is making my kids trans or something, like YouTube videos are turning my children trans. And then immediately, like in the same paragraph says, like I spoke to a parent who said that they like to moderate the positions that they take in order to get into media appearances, such as the one that I'm writing -- she doesn't say such as the one that I'm writing, but you know what I mean?

But I think that looking at the way actually that this kind of, as you both are mentioning, very distended portrait of this overall fight is positioned as, I think, the way that it's arranged actually tells me something very explicit, which is that this is reflected in a lot of different ways that liberals tend to talk about anything related to health care, but also a lot of other social issues, which is kind of like in, I think, for instance, the specifics of this debate, it's like liberals saying, oh, what do you mean, of course, it's reasonable to demand higher scrutiny of kids who just want to transition, just because like, you know, they're imagining kind of being in this fantasy world where like transition or any kind of medical care is just subject to like medical jubilee or something, like as though anyone can just like get anything, any kind of care at any time, as though there aren't massive barriers to even just finding and getting to medical care.

And so that's -- I think that's where it kind of opens up and it just becomes this well, you know, of course, we've we've reached the -- I mean, Charlie mentioned like the end of history before, like we've reached the end of history, the arc of history has bent already. And we're in kind of this moment, where of course it's reasonable, because so many kids can get care, it's -- I know that's incorrect -- but like, where from the liberal perspective, it's like, of course it's reasonable to demand psychologic -- like a battery of psychological tests on trans children who say that they are what they are, because like, you know, it's like operating --

Beatrice Adler-Bolton 31:16

Gold standard.

Artie Vierkant 31:17

In this fantasy realm of care is just accessible and free, even though like, obviously, we live in just a horrible hellscape of the political economy of healthy in the United States.

Jules Gill-Peterson 31:27

Yeah, I mean, I think there's a big story going on here, you know, about basically what I would call the sentimental form of American liberalism. It is about a certain feeling of rightness and relationship to power, right? And it's just astounding to me to watch this happen, in part because, you know, it gets harder and harder to become -- like to feel confident that you're right, when there are incredibly authoritarian, illiberal, anti-democracy and white supremacist groups just like actually installing, you know, a Christian state, all over the place. We actually do have to work harder, right, to be like, no, no, no, no, no, it's all good, right?

And so, like, you know, I had this interesting experience only a few days before this Bazelon article came out, you know, there was this UCLA study that purportedly showed that there are more young people who identify as trans and non-binary now, and like, you know, separate podcast episode could be about like, what the hell is the point of studies like this, I literally don't care how many trans people there are in the world, because it doesn't matter. Like the amount of trans people in the world has nothing to do with whether or not we have the right to exist. And so like gathering data that is completely unreliable, it just seems like silly and setting us up for failure. But you know, I went on, as you do, on NPR to talk about this. And, you know, I was talking -- you know, the host gave a good interview over, I think, but it was so interesting, because I was sort of laying out this basic explanation, like, okay, so these are self identified numbers. And because of social stigma, there's actually just no reason to believe that they reflect anything demographic or empirical.

So they can't really tell us very much, except that like clearly, young people are less afraid than older people to be out and talk about their identity. That's really all it can tell us. And so then, you know, the host was like, okay, so what about people who are afraid that young people are just too zealous in their identifications? And I was like, well, they aren't, so. Like I see no evidence of that, no one has ever shown me how that can possibly be true. And even if it was true, it doesn't matter. It's an irrelevant point, because I don't think being trans is bad. But it was really interesting, the sort of follow-up question that she offered to me was like, well, you know, and I was like, well, why would we think being trans is trendy, desirable or good?

It's literally illegal for young people to transition in Alabama, and there are policies ripping trans kids out of their families, putting them in foster care, there is more scrutiny on trans young people than ever, they are more likely to be harassed, targeted and bullied every single place they go, what exactly would be so exciting about that, that people would be like, that's what I want to do. Right? And it was so interesting, because her response, I think, really -- you know, I don't think it was this host's -- her own fervently held belief, but she parroted this kind of -- or ventriloquized this response, I found really interesting. She was like, well, that might be true in Alabama or Oklahoma, but here in Los Angeles, you know, I just don't think these kids know, they just -- they have it really good, right, and they just don't know what the real costs are to being trans. They don't know how much they'll suffer. And so maybe they just get carried away in their friend groups online. And I was like, okay, well, you know, that shows once again that childhood mostly operates as a fantasy that adults have about how young people behave. I was like, none of that opinion says anything about how young people use social media or form community. It just like is completely a made up idea.

But it was really revealing to me, this idea that like as literally the majority of states impose incredibly violent, disenfranchising legislation that strip trans people, not just of civil rights, but any participation in society in order to reduce their numbers in the world -- aka eugenics, right, state eugenics -- that will actually lead to a doubling down on the idea that like, well, but in California and New York, whoo, the kids are out of control with their transness, that it's like, wow, like real time fracturing the Republic much? It's a really interesting kind of emotional response, right? I think this is what Charlie was really underlining so well earlier, this idea of like, “Oh, no, no, no, no, I'm not a Christian evangelical, right? I actually don't support the January 6th riot. I vote Democrat. [feigned shocked voice] Oh my gosh, no, no, no. I just also think that, you know, children don't deserve basic dignity and respect or access to health care, and that they're my quasi property. I'm a good liberal, right?”

And I think that like this is where -- you know, it's important to me, obviously, I have a bone to pick with Emily Bazelon's ethics as a journalist, and I feel a little annoyed that I was one of, I'm not even kidding you, dozens of trans experts that spent a lot of time with her, that she then just sort of, you know, left out to dry. But I actually -- it's like, you know, she didn't invent this issue, and she didn't invent this form. And I actually think it's a really significant problem that we're facing in this moment, where I just see this kind of doubling down on sentimental politics, where children are perfect for this, right? This is what children, "child," the concept was invented for. It was invented for letting your fantasy of how you think the world could work, because you're a good person, override what is actually happening. And it actually is the way that you ideologically justify violence as humanizing, as caring, as loving kids, right? This article records so much mistreatment, harassment and violence against children, it records and openly discusses the abuse of children by institutionally embedded people who are given responsibility over them, whether it's parents, educators, politicians, or doctors, psychiatrists, psychologists, and social workers, and they celebrate the harm that they have done as properly caring for those young people, right? That is chilly. Right?

But of course that's not how the article presents it. But we have to really think about this is the ideological function that we come together around in American culture, right? Loving children means harming them. That is just completely normal business as usual. And it really, really disturbs me, again, to just see how intensely trans children are available to reinforce that structure for [emphasis] everyone, right? It's like, you have these incredibly naive doctors being like, but my God, what if an imaginary child in the future regretted something that I let them do, even though that hasn't happened? But what if it did happen? And yeah, and then, you know, the state of Ohio is like, totally, totally, totally.

Anyways, while we're at it, we're going to mandate that any adult can have a child, a girl, you know, playing on sports, be pulled out and subject to an external and internal genital exam, you know, by fiat, to determine that she isn't trans. And it's like, hello, these two things are connected. They don't just live in the same universe - they are directly dependent on one another for mutual existence. And it's just the mechanics of disavowal here. I mean, I really do have to say -- and I'm belaboring this a little because I think it's really important. The mechanics of disavowal, right, are what take naked violence, naked hierarchy, naked dehumanization, just brute force that adults exert over children, and dress it up as the opposite - as love, concern, and care. And so we really have to undo that emotional arc because it's actually a -- you know, it's a perversion, right? It's a perversion of the meaning of something, and to take it from being, you know, a sort of gross invalidation and violation of young people's bodies and autonomy and turn it into something that is loving and caring and responsible and actually reflects how good adults are, right? And I just think when we really slow down and do that work, you know, it's just so staggering. I mean, how could we be okay with this?

Artie Vierkant 39:43

I think that's extremely well said. And I think that one of the things that you were mentioning earlier in your comments, this kind of throw to -- sort of on top of all of this, Bazelon kind of throws to this almost -- talking about like coastal elite status, basically, of all these things and kind of saying basically like, either outright suggesting or heavily implying a number of things, but one of them is like kind of this -- she more or less implies -- and I'm really curious, and I think especially to get both of your take on this -- she more or less implies that the quote unquote, the putative rise in young people identifying as trans is in some part like a signifier of white privilege, and then goes on to -- says that essentially like, you know, she mentions how common that it is to see in like these gender clinics, that she I think has visited, like a larger amount of white trans kids. She then says, for example, after quoting one of these people who's complaining about how like YouTube videos made their child trans, Bazelon says, "Online, where the stakes start relatively low, teenagers and progressive communities can trade-in a cisgender, heterosexual white identity, the epitome of privilege and oppression, to join a community with a clear claim to being marginalized and deserving of protection." I found this statement like staggering to --

Beatrice Adler-Bolton 41:14

Horrific.

Artie Vierkant 41:15

To read, I mean, here. I'm just very curious what you both made of all of this.

Charlie Markbreiter 41:19

Yeah. I mean, I think one thing that this conversation has definitely clarified for me is how much weirdly anxiety about trans, and especially childhood transition, is also an anxiety about the internet in a weird way. And in some senses, this is like not specific to trans people or to this issue, like I'm thinking of previous sort of moral panic debates about children looking at porn on the internet. But yeah, I guess sort of, if you take a more zoomed out look at it, it's not -- the question is like, okay, so why is the internet the only place where these trans kids are getting access to this information? Maybe it's part of a broader process of austerity and institutionalized transphobia, both institutionalized within the school and within the family, that makes it impossible for them to get that information anywhere else. So of course they are turning to the one place that they could get access to it. And even though it's easy to look at this kind of scare-mongering and think like oh my god, there are more trans people than ever, but it's a very common experience for trans people to literally not know anyone else trans in person. Like people on the server, the Death Panel Discord, have had that experience. I teach at Queens College in Queens, in New York, which is, you know, obviously, I'm a coastal elite teaching supposed coastal elites, but some of my students are like, yeah, I didn't know a single trans person in high school, and I was hoping to meet some in college, you know?

So I feel like that really -- it's funny, you know, seeing places like New York or LA painted as these sort of like trans utopias posited as if they could like make up for the total abyss of trans care in the rest of the country. Like oh, it's fine. We don't have to worry about any other city or state in America, just New York or LA, you know, then we're set. But it's like, yeah, there are more trans people in New York, but that isn't actually good. It's because so many trans people are literally fleeing their states, and are going to like where they think resources are more available, which is why I have like a sort of ambivalent time thinking of New York as this trans utopia, because it's like, yes, on the one hand, it's a lot better here than it is in like, I don't know, North Dakota, and there are a lot of trans people here, but a lot of times it's because they are like desperate for resources that they couldn't get elsewhere. And I don't really think that's a thing we should be like, celebrating, you know?

Jules Gill-Peterson 43:58

Exactly. And you know, this -- thank you for zeroing in on this moment in the piece. It's quite egregious. It's a good example of not just bias and sort of peddling an ideological line without context, it's also -- it verges on, I would characterize it as disingenuous in its relationship to facts and truth, you know, verging on disinformation, right. Okay, Emily Bazelon. You go to the gender clinics, right. And you happen to notice that most of the trans kids there are white. Huh, I wonder --

Phil Rocco 44:29

[exaggerated incredulous voice] I wonder why that is.

Jules Gill-Peterson 44:30

I wonder why in the United States --

Phil Rocco 44:31

Why would that be, in the United States? [laughter]

Jules Gill-Peterson 44:33

I really wonder, yeah.

Phil Rocco 44:35

[inaudible] clinic access, hmmm.

Jules Gill-Peterson 44:37

Well, yeah, just like in American healthcare, has it ever happened before that white middle class people have had greater access to health care? And again, again --

Beatrice Adler-Bolton 44:44

Shocking [laughing].

Jules Gill-Peterson 44:45

You know, I just happen to have written a 225 page peer reviewed book that actually explains the historical process by which it came to be that gender affirming or trans medicine is disproportionately available to white middle class children, over all other trans children, right? And so, you know, it's again this kind of incredible set of intentional misrecognitions, right. So if you think that being trans is a medical condition, which it is not, and you think that trans people only exists because medicine exists to make them trans, which is untrue, then you could -- then you could take whoever is at the gender clinic as somehow meaningful about what it means to be trans, right. Whereas in reality, again, if it's so attractive for white college educated, big city dwelling, nominally progressive kids in search of a kind of identity politics that feels clout-y and cachet-y in this moment to be trans, guess what they could do to be trans or non binary? Just say they are.

They could just change their pronouns and say they're trans or non binary, right? No one has to go to a gender clinic to prove that they're trans, right. And actually if you just wanted to be trans for clout, I don't think you would go to all the trouble of transitioning, because it's actually almost impossible to do that, and really difficult, and really complicated, right? And so it's like, well, yeah, like the trans community already has its own racial critiques, right, trans of color critiques of like the white aesthetics of non binary or something. But that has nothing to do with the medical clinics in this moment. And so again, it's just this like willful, [emphasis] willful abandonment of context. And anyone who's responsible in their relationship to facts and the truth would not like make those decisions. It's just such an absurd idea. And I really do take umbrage to it, again, because it just so flagrantly disregards actual research that people have done, right? It's like, we already -- it's again, it's like you could just be like, huh, I wonder -- I wonder if this might be true.

But then if like 20 people with PhDs have already like proven that that question makes no sense and have a much more like on the ground compelling explanation and context for it, then you're actually just being irresponsible, right? Like I could understand if there was no other way to know anything about trans youth, okay, maybe. But like there are literally so many [laughing] peer reviewed books by scholars, and all of them have the same kind of analysis, that in fact, the disproportionate white middle class-ness of the youth at the gender clinic is like a really serious problem and symptom of a broken institution and a broken system. And again, it's just like the height of American kind of indulgence in the privatization of health care to be like, my goodness, the only people who go to the doctor are the ones who want to be there. No one else could, you know not be there, right?

And I just -- again, I've said this so many times, and it's really bothered me, you know, because part of what this extreme ant-trans political violence kind of rhetorical environment we've been living in for the last few years in the US has done is it's actually radically narrowed the way that trans youth are framed, because so much has been framed, despite everything, right -- if you look at the range of legislative and political and administrative attacks on trans youth, they are all encompassing, they encompass every single aspect of public life. And yet the number -- like the only ones that are ever focused on are the sports bill, because that just plays well as a moral panic, and then the health care thing. And it's like part of the problem, again, is that like as horrific as those bans are -- they're horrifying, right -- they actually don't even -- they're just not even the tip of the iceberg of the story.

And it's like, well, you know, what other kinds of trans youth don't even make it into the Bazelon Expanded Universe is like, yeah, what about most trans kids? Most trans kids aren't these kids. Most trans kids actually don't live in states where they're going to gender clinics. Most trans kids don't have supportive families. Most trans kids aren't even recognized as trans, right. And for, you know, black and brown trans children, especially trans girls, they're much more likely to have their gender nonconformity taken as an accelerant to intensify forms of racial policing and forms of quasi-incarceration; it's the school to prison pipeline story. And so actually, transphobia is serving as a way to intensify a regime of policing that is primarily formed out of racism, that actually is just like, ooh, transphobia's really helpful to pursuing my goals. And like, imagine, [emphasis] imagine if that kind of piece, if that piece of the story were in this article. And of course it's not going to be, because I talk to clinicians all the time, and they're barely aware of their own blind spots there. It's just like, again, thinking that -- I think really, you know, the other part of the story, and it was sort of a thing I ranted about on Twitter the day that this was published, is like the medical establishment is not progressive and they have benefited so much -- [emphasis] so, so, so, so much from anti-trans political violence, because it makes them seem more reasonable, and it makes them seem progressive. It makes them seem like oh, well they're against right wing legislators. And it's like, well, they are, but they're only against them because they don't like their authority being challenged by anyone. They're not against them because they are for trans people, or working in trans people's best interests, right. And it's like, you know, I think one of the -- there's some weird stuff going on, right?

At one point we meet Marci Bowers, who is this trans woman surgeon, who got in a lot of trouble, because she's apparently so politically naive that she gave a long interview to Abigail Shrier, the anti-trans freelance journalist who wrote Irreversible Damage, right? And this happened, this interview came out where Marci Bowers right, like, did this kind of -- you know, I don't know Marci Bowers, I know lots of people who know her. So like, whatever, I don't think she's -- you know, I think she's just sort of symptomatic of a larger problem, right, where it's like to become a surgeon, as I like to famously say, I think you have to be kind of a sociopath because you have to be willing to just like see people as like flesh that you can cut into and like, thank you for that, surgeons, like thank you for being able to do your job. But like, they're not always very politically savvy people. There's a reason why the Stonewall Riots weren't led by plastic surgeons, right? [laughter]

So Bowers ends up talking to Shrier, and Bowers is like, hey, you know, she's not a public health researcher, right? She's not engaged in trans research. She's a surgeon and see, she has a kind of anecdotal empirical data set, which is all of the surgeries that she's performed, just by sheer number. And she's like, oh okay, you know, in my experience doing vaginoplasty, you know, when trans women transition really, really young, and suppress puberty actually before puberty has even started, like, yeah, you know, sometimes vaginoplasty is a little harder for me to pull off when they're adults just because of tissue growth and stuff, and that might affect their experience of orgasm. Okay. Okay, so she has this like little bit of anecdata. It's a really tiny, tiny, tiny group of people. There are almost no trans women who fit all those criteria, so it's not like a lot of people. It's not a population that's actually like growing in any particular way. And like she -- her concern is actually nominally fine, she's just like, I think sexual pleasure is important and trans women deserve it. Okay, cool. But her political know-how was so wonky that she was like I know who I should talk to about this - Abigail Shrier. She'll definitely write a really good piece about it, and she just like doesn't get it. Okay, cool. But then Emily Bazelon is like I'm just going to retell this whole story without any of that context, right?

And then it's like, oh, well, no wonder someone is going to read this and be like, oh my god, trans surgeries are butchering people's bodies, and they have no pleasure, they can't feel anything, right. And it's like, okay, those are all lies, but like you really can't trust medical professionals to be leading a political movement. In fact, they are not leading a political movement. The only people that think doctors are in charge of trans people is The New York Times, right, and like right-wing conservatives. No trans people think that, because we barely even get to the doctor in the first place. It's like this is just showing, see how many layers it takes to distort reality, right? Disinformation takes time, and that laundering process often has many steps, and it goes through many different people's laundry machines, in part so that no one can have all the blame placed on them and it isn't actually conspiratorial right? I don't know, I don't care about Marci Bowers' like intentions or not. She was really clumsy. She made a really huge political error, whatever, it could have been any number of other surgeons, right. Then, same thing for Bazelon. She really kind of did a bad job on this piece, but any number of other journalists could have done it.

The point is that this is sort of spread around so that no one has to believe that they're putting a hit out on trans youth when they're just participating in this long, slow sort of digestive process that takes something that, in its kernel, is a question that some people should be talking about, right, like trans women, who have a stake in vaginoplasty outcomes, right, with their surgeons, and in concert with activists who put pressure on the medical establishment, but it gets laundered and laundered and laundered and laundered and laundered, and then all of a sudden, right, it's armature for right-wing legislators who want to create blanket bans on access to health care, based on this One Weird Story that they heard. It's basically a long game of telephone, right? So it's like, everyone has plausible deniability. No one can actually be said to be intentionally making stuff up because they're literally all distorting the truth all the time to the point where they wouldn't even know who's making up what, right? It's the perfect machine for getting hateful politics done.

Beatrice Adler-Bolton 55:06

Right. And I think this is such a great point, Jules, and I appreciate you bringing this in, because I think it's really sort of well evidence, like what the material impacts of this kind of process of translation is, for example, in the misunderstanding of what the point of a psychiatric evaluation is, in the process of transitioning, because in this article, over and over and over and all over the place, right, you see the psychiatric evaluation invoked as the thing to sort of make sure that the person seeking that transition care has --

Artie Vierkant 55:41

Oh my god, incessant. It's like --

Beatrice Adler-Bolton 55:43

Right, has sufficiently provided burden of proof, right.

Artie Vierkant 55:46

And god forbid a trans person also have autism or ADHD, or I don't know --

Beatrice Adler-Bolton 55:51

Or any other diagnosis, even.

Artie Vierkant 55:53

Like asthma or something, practically, by the sound of this article.

Beatrice Adler-Bolton 55:56

And there's this kind of framework, right, of like, oh, well, we have to have these like sufficient levels of mental health supervision in order to make sure that there's not regret in this scenario. And this is very much framed as like an individual and personal decision and a kind of private medical matter, right. And the sort of psychiatric mediation is treated very much as in the benefit of the person seeking care. And that's absolutely the opposite of actually how that historically entered into the process of being a kind of prerequisite or a guardrail to trans care. And I wondered if we could get into this specific component a little bit, too.

Jules Gill-Peterson 56:36

Yeah, I mean, it's just really quickly, like that characterization that we get in the article, which is, you know, a very common characterization -- it's straight up a lie, right. It's incredible because, I don't know, again, credit due to the incredible prevaricating, obfuscating power of this journalist, like the only trans studies scholar she cites in the piece is a historian, Beans Velocci, who actually -- that piece is amazing, the Velocci essay in TSQ. I helped commission it and helped edit it. Love it. It's fucking brilliant. Beans is brilliant. Like how dare Emily Bazelon use their work in this way.

Because people wouldn't -- again, who would know this, right, you don't know unless you're trans and you go through this, right? Why is there psychiatric evaluation in trans healthcare, right? Trans health care has nothing to do with the mind. These are all physical -- forms of physical health care: hormones, surgeries, right? They don't have anything to do with your mind. So why is there -- people think, oh well, yeah, it's the supervisory process. The point of the psychiatrist is just to make sure the person is really trans. No, it's not. That's not what they do. Guess -- first of all, do you want to know why? Because you cannot, there is no test in the world. There never has been. Trust me, they've tried. You cannot evaluate if someone is really trans or not. It is impossible, right? And so why do we have these psychiatric evaluations? Is it for medical and psychological and psychiatric reasons? No, it's not! It's to -- if you go back and look in time, Beans explains this with our friend, Harry Benjamin, back in the 1950s and 60s, right. Benjamin developed this requirement and to codify into the standards of care, because he was afraid that trans people would sue him for being a bad doctor.

And so was the surgeon, Elmer Belt, that he was sort of collaborating with in LA in the 1950s. They were like, you know, these trans people, you know -- I mean, they had terrible, disparaging views of trans people, they're like these sick people, like we got to help them, right, because we can't stop them from being trans. They don't respond to psychiatric or psychological treatments. So let's let them transition. But goodness, you know, they might -- they weren't worried that they would regret transitioning, they were worried that they would regret working with them as doctors because they couldn't deliver on what they were promising. And so they developed this system, they're like, well, let's send them to lots of psychiatrists, because then truly only the people who the most believe and are the most desperate for the surgery will get through that process, and they won't sue us. That's seriously it. Like Beans went back and has the receipts. It's like really good research history.

And then in my book, I looked back even further -- in the 1930s, when some of the very first trans people are showing up at Johns Hopkins Hospital, because they've heard hey, at Johns Hopkins, sometimes people's sex are changed, right? This was intersex people who are having, you know, non-consensual, really awful medical procedures imposed on them, right. But trans people started to hear about this and were like, okay, well, that's terrible, but like, I actually do want to transition, I do want to change sex, right? So I'm gonna go to this hospital and I'm going to present myself as intersex, right? And so a couple of them start doing this. I talked about a trans guy, for example, named Bernard in the 1930s, who travels from the deep south to Hopkins in the 30s and meets with the urology -- the head of urology at Hopkins and he's like, hey, what's up, surgeon? I am intersex.

So, could you just give me, you know, some surgeries to make sure my body conforms to the maleness it's supposed to be? And amazingly -- like I read these medical records, right, the urologist is like, okay. He's like totally -- he's totally taken and charmed by Bernard and is like, I guess you must be intersex because they don't know, these, like doctors are all full of shit, right? So but then he's like, well, I don't know, you should go talk to a psychiatrist just because like, you know, I got a lot of pressure on me to be conservative. I'm a doctor in the 1930s at bloody Johns Hopkins. And there are all these psychiatric files from other patients too, where psychiatrists are like, oh my gosh, who are these people who want to change sex? This is so weird. I don't understand. I have no reference point for this.

Like literally, it's like watching a psychiatrist post their Ls, where they're like, “Well, I once read a little bit of Freud, but you know, my German's very bad, and I'm so confused. Who are these people? There's nothing biologically different about them, but they feel they are the opposites. Oh my god. Well, we can't let them do…” -- right. And so it's like, you go back and look at why we have these psychiatric requirements. They have nothing to do with anything legitimate. They're just literally people being like, “I don't like these people. Let me put some roadblocks in their way. I'm very threatened by their self knowledge. I'm threatened by their agency.” And psychiatry is mostly used as a weapon historically. Like what do we think psych hospitals are for, people? And why do we think constantly, you know, any association of trans people with mental illness or madness, right? Or, you know, neurodiversity is always used against them. It's just straight up eugenics, right? It's like, well, we don't like these populations. We don't want them in the world. And we're going to try and use psychiatry to control them.

And I swear, I swear, if any single newspaper of record or magazine had to actually answer why psychiatric evaluation is part of trans health care, for the exact same procedures that non trans people can get all the time without psychiatric evaluation -- I mean, people would be shook, right? Because the whole edifice, the whole house of cards completely crumbles at that point, when you're like, huh, so there's actually no reason other than hate, hatred, and animus, and bias against this population to sic a bunch of psychiatrists on them.

Meanwhile, like, you know, I just think about it all the time, like one of the gender affirming surgeries I had that I absolutely love and celebrate is that I had an orchiectomy a few years ago. And I remember, right, it's fully covered. I remember it because it was a few years ago, congratulations to me having memory that goes back three years. Okay. But, you know, I had insurance that covered this procedure, I had already been living as trans for a long time, had been transitioning for a long time. I had a therapist anyways, right? Like, I had all the things and my insurance was like, great, we're just gonna need like three letters from -- including from psychiatrists who doesn't even know you and has never met you before, proving that you're not insane for wanting this orchiectomy. And so I'm going through all of the hoops, right? And so, you know, I basically ended up using one of those annoying neoliberal like trans healthcare apps, because like you can basically be paired with like a letter writer that day over video chat, which is like path of least resistance -- you got to pay out of pocket for this, by the way, right? And so I go, and I'm talking to this guy, this nice gay guy in Philly, who's like, I'mma write your letter, don't worry. And I was like, thank you, thank you for not being a creep, because I've been sexually harassed by psychiatrists before in these kinds of settings, and they've been really difficult. And he's like, I got you. And he was like, by the way, you're just getting an orchie? And I was like, yeah. He was like, you know, your urologist just could have coded it not as gender affirming. If he had just put in the insurance code for -- and you're never gonna believe this -- testicular pain, you could have had the surgery like the next day. There would have been no supervision at all. And guess what? This is here -- here's the real -- the juicy bit, right? An orchiectomy for a trans woman and a cis man: exactly the same procedure. There is no difference whatsoever. Zero. ZERO, right?

And so it's like a guy, you know, I'm sure not a lot of cis men want orchiectomies, right? But let's say they did. They can go in and be like, owww, you know, it hurts. And the doctor can be like, let me take these -- let me take these goodies out, right? But a trans woman comes in, is like -- also, I was like, honey, I have pain there. Let me tell you about the pain that these external gonads have caused me, right? And that doctor has to be like, totally, totally agree. Anyways, would you go spend months getting three psychiatric evaluations to determine that you're not medically insane to make this decision about your own body that a dude can make with -- you know, just on a whim, right?

It's just like, come on. If that was how these things were narrated to the public, what conclusions do you think they would draw? And so I'm just like enough. Enough misinformation, enough misrepresentation. Stop lying about how trans health care works and actually tell one legitimate story about why it works this way, how it got to be this way, and watch, all of a sudden, you can't put out these pieces anymore because they're not going to satisfy the ideological demand that is driving them in the first place.

Charlie Markbreiter 1:05:13

I mean, Jules, what you're saying really reminds me of the sort of rhetoric that people usually pull out, of like we need to stop this flood of children who are trying to access trans health care, when actually what you're showing, right, is that what we have is not a flood of children, but like a flood of gatekeeping. So it's like, okay, if that is actually the material reality, then why is this emerging as a problem now? And sort of like, what does that tell us? And I feel like one entry point into that question is something that you've talked about a lot, Beatrice, which is this kind of like austerity mindset, where, you know, I feel like sometimes when people are drawn to these issues, it's because they're like, well, I've been so fucked over by the medical industrial complex, I have so much medical debt, and you think you can just walk in there for free and get penis? Like, what the hell? [laughing] You think this is a penis store? No, this is not a penis store.

And so it's sort of like an expression of, you know, as you guys have covered thoughtfully and extensively, the way that austerity has destroyed American health care, but it's also like instead of -- part of what being austerity-pilled means is that instead of being like, hmm, maybe I should have some kind of system that would benefit not me, but others, you're like, oh, how dare someone else get more, I need to kind of like destroy them in some way. But what's interesting about that is that like, if you think of, you know, who Emily Bazelon is, and sort of who The New York Times readership is, this is a sort of like white collar audience, right? This is not the kind of readership where hundreds of thousands of dollars of medical debt, or only being seen in the emergency room is a part of their daily lives. Like this is for people who have insurance. So it's like, why is this being framed as a problem, not just when it isn't on sort of a national scale, but for these readers in particular. And, again, maybe this is me, as always, forcing my own niche, special interests onto things.

But I was obviously thinking through some of this stuff through the scholarship of Lauren Berlant, and this is kind of like pedantic, Artie, so feel free to like cut if you're like, Charlie's just going off on theory bullshit. But so someone in the server mentioned during reading group one day, sort of this distinction between positive and negative liberty, where like positive liberty is kind of just like getting what you want on a kind of individual and collective level. And negative liberty is a sort of freedom from all external restraints, or what Berlant calls sort of like, freedom from the sort of inconvenience of other people, by which they mean like, sort of having to -- basically just having to admit that other people exist. And as our austerity state increasingly gives us less, sort of one of the only ways that it sells itself back to us and keeps us attached in a kind of cruelly optimistic relation is, okay, so I'm going to destroy the social, but in exchange, I'm going to give you individual freedom, not as positive liberty, but only as negative liberty. So I can't actually give you what you want, right? Because neoliberalism can't actually give you any form of thriving, but I can give you negative liberty in terms of the sort of freedom from the Berlantian inconvenience of other people.

So I think that this actually really lends itself to how trans people can be scapegoated so easily, because it's not that -- you don't actually have to prove that they are impinging on anyone's positive liberty, like I promise you, even someone getting penis is not going to prevent you from getting cancer treatment. But that doesn't matter, because all you have to prove is that in some abstract sense, trans people are impinging on your negative liberty. They're providing -- they're proving an instance of the inconvenience of other people. And I think in an increasingly authoritarian environment, in an increasingly austerity strapped environment, where we're told that if you are an inconvenience in any way, you can be eliminated very fast, you know, calling someone a kind of inconvenience has high stakes.

And in “Can't Take A Joke,” this [2019] interview [I did] with Berlant, one thing they said that really stuck with me is they said, "Trans people are cast by some of the people they're inconvenient to as inappropriately demanding, as in how dare anyone outside the current settlement of normative life demand to be the referent and inconvenience other people's casual relation to language, nature, taxonomy, gesture and concept. Even the smallest claim, such as not to be addressed by one's state-sanctioned name and the pronoun conventionally attached to it, has been called 'too much.' Bah. Politics exists wherever we're inconvenient to the reproduction of normative life, the conventions and institutions of that life. A lot is at stake even in the most specific of demands."

So yeah, thank you, Lauren Berlant.

Beatrice Adler-Bolton 1:10:35

Yeah. And I think I mean, it speaks to this kind of idea that people need to like justify or prove that they actually deserve care, right? And that's ultimately kind of what is up for debate right now in terms of like what Bazelon is saying that she's covering with the new guidelines and this kind of like golden standard of care, which is this always perfect search for the right gatekeeping mechanism or the right guardrails to protect people from themselves. And like, ultimately, what that does is it sort of frames transness, both like, incorrectly as a kind of mental illness, but it also puts in these sort of arbitrary constructs where we begin to completely change our understanding of like, what the role of psychiatric authority is in that sort of medicalized process. And you know, this is like a conversation that like, you know, it's no wonder The New York Times covered horribly, but I really appreciate the two of you coming on to just like help break this down in such depth.

Jules Gill-Peterson 1:11:30

Well, thank you. I mean, I think that the resonance is real, right? The only response, the only politics that is capacious enough, sophisticated enough, and robust enough to counter this nonsense is to say everything for everyone, right? It's just, we're not here to decide who deserves what. We're here to make everything available to everyone who needs it. And so then, all of these false moral dilemmas and liberal eugenic plots will evaporate in an economy of abundance. Because guess what? We have more than enough penis and more than enough not penis to go around. And that that works because it's funny, and it brings a smile to our face, but it's also just literally true. Like penis for all. No penis for all. That's a great politics, all for it.

Artie Vierkant 1:12:17

Hell yeah.

Charlie Markbreiter 1:12:18

I actually am from the guardrails community and I disagree with that [laughing]. But that's okay. No, I'm just kidding.

Beatrice Adler-Bolton 1:12:27

Well, I think that's a good place to leave it for today. Jules, Charlie, thank you so much again for coming on.

Artie Vierkant 1:12:32

Thank you both, seriously.

Phil Rocco 1:12:33

Indeed.

Beatrice Adler-Bolton 1:12:33

It's been an absolute pleasure. And again, you can preorder Charlie's first book, Gossip Girl Fanfic Novella, which is out from Kenning Editions this fall. You can follow Jules on Twitter at @gp_jls. We've really appreciated having you both on.

To support the show and get access to all of our weekly patron exclusive bonus episodes, become a patron at patreon.com/deathpanelpod. And if you'd like to help us out a little bit more, share the show with your friends, post about your favorite episodes, preorder Health Communism, or request it at your local library, and follow us @deathpanel_.

As always, Medicare for All now, solidarity forever. Stay alive another week.

Death Panel 1:13:15

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Transcript by Kendra Kline. (Kendra is currently accepting freelance transcript work — email her if you need transcripts!)