Photo: Ted Eytan via Wikimedia Commons. I decided to focus my message today on trans issues because it’s what made me the most angry this week. And it’s only Tuesday night. A major fight is happening right now over gender-affirming care. Or actually, it has been attacked over and over this past decade. It’s just getting worse as the rhetoric gets worse. This healthcare is essential and even life-saving for many people, but it is getting mowed down politically and institutionally, largely because most people don’t fully understand what it is. The current public discussion is loud and often scary, but it’s built on a major misunderstanding. These attacks are coming from several directions, hitting both private institutions and potential federal law. The U.S. Conference of Catholic Bishops (USCCB) recently put an official ban on gender-affirming care in all Catholic hospitals. Since Catholic healthcare is a huge part of the U.S. system, this decision makes it much harder for transgender and gender-diverse people to get care. “Just don’t go to a Catholic hospital or medical clinic then!” they say. Well, the problem is in some places, the only hospital or clinic is the Catholic-affiliated one. Doctors at these facilities are now forbidden from offering hormonal or surgical treatments that help someone match their body to their gender identity. In Congress, the U.S. House is expected to vote on H.R. 3492, the “Protect Children’s Innocence Act.” This bill tries to make it a crime to offer gender-affirming care to minors, falsely calling it “mutilation” or “chemical castration.” If this law passes, doctors who provide this proven, necessary care could face up to ten years in federal prison. It’s important to note the contradiction here. While the bill seeks to stop this specific, consensual care for trans youth, it oddly leaves room to allow non-consensual surgeries on intersex infants and children, a practice human rights groups strongly oppose, arguing that those decisions should wait until the person is old enough to agree. The most common public idea is that gender-affirming care just means a big “sex-change” surgery. This is wrong. This incorrect idea is what is driving the push to ban the care. Gender-affirming care is a complete, personal plan that involves a range of support. For the vast majority of people, especially younger people, it does not involve surgery at all. The care usually starts with social affirmation. This is non-medical and completely reversible. It simply means using the person’s chosen name and pronouns and allowing them to present themselves (through clothes or hairstyle) in a way that aligns with their gender identity. Next is mental health support, which is crucial at every age. This involves counseling and therapy to help the person understand their gender identity and deal with gender dysphoria. This is the deep unhappiness that comes from their body not matching who they are inside. Therapy is also vital for addressing common mental health issues like depression and anxiety that affect gender-diverse young people. Medical steps are only taken after careful discussion with doctors and parents, following clear medical guidelines for different ages. These steps are mostly non-surgical. Puberty blockers temporarily pause puberty. This gives a young person time to explore their gender identity before their body changes in ways that are hard to undo; these blockers are fully reversible. Hormone therapy involves giving estrogen or testosterone to help a person develop physical features that match their gender. This is partially reversible. [By the way, there was another report this past week that more and more men are asking for testosterone treatments because they feel less virile, manly, or even have less sculpted bodies because of lack of testosterone. These are straight men wanting this. Guess what?! That’s gender-affirming care!] Surgical interventions are rarely done for minors. They are mostly reserved for adults, or sometimes older teenagers with extensive medical review and parental consent. Surgery, such as chest reconstruction or genital reconstruction, is the final option in the process and is not required to be considered to be receiving gender-affirming care. Gender-affirming care is standard, evidence-based medicine. It is supported by every major medical and mental health organization in the United States, all of which stress that decisions about care must stay between the patient, their family, and their doctors. Not politicians. The American Medical Association (AMA) calls attempts to ban gender-affirming care a “dangerous intrusion into the practice of medicine.” It states that medical and surgical treatments for gender dysphoria are medically necessary and opposes any laws that criminalize or prevent the provision of this evidence-based care. The AMA also supports protections for physicians, patients, and families who seek or provide this care. The American Academy of Pediatrics (AAP), the nation’s largest group of children’s doctors, stresses that there is a strong consensus that evidence-based, gender-affirming care for transgender children and adolescents is medically necessary and appropriate. The AAP describes its policy as a “holistic, collaborative, compassionate approach to care with no end goal or agenda,” emphasizing that this care can be life-saving. The American Psychological Association (APA) strongly supports “unobstructed access to health care and evidence-based clinical care” for transgender, gender-diverse, and nonbinary individuals. They note that supportive mental health care greatly reduces the risk of depression, suicide, and other negative outcomes for transgender youth. Psychotherapy in this context aims to help young people explore and understand their gender identity, not change it. The Endocrine Society, as the experts on hormones, provides the clinical practice guidelines for medical care. They support gender-affirming care, confirming that treatments are tailored to the individual and that medical intervention is reserved for older adolescents and adults. They also affirm that puberty-delaying medications are generally reversible and give individuals time to make decisions. The consensus is overwhelming! This care is safe, necessary, and, studies confirm, leads to significantly lower rates of depression and anxiety, and a decreased incidence of suicidal ideation and attempts. For these individuals, this care eases the pain of gender dysphoria, helping them feel comfortable and genuine in the world. It is care that helps them live well. The current political and institutional actions are not designed to protect children; they are designed to take away life-saving medical treatment from a group that desperately needs it, based on a mistaken idea of what that treatment is. We must understand the whole range of gender-affirming care and the uniform support it has from the medical community to push back against these harmful policies. So what do we do? Call and write your member of Congress. Hell, visit them at their offices. Educate these ignorant folks making medical decisions for other people they know nothing about. Got relatives and friends in red districts and red states? Send them out to educate their ignorant members of Congress, too. Get full access to Not Quite Communist by Gerald Farinas at gerfarinas.substack.com/subscribe