Protests are pretty common at the Little Rock, Arkansas, clinic where Dr. Janet Cathey works. After all, she works for Planned Parenthood. Controversy is practically part of the job description.
But at one recent protest, Cathey noticed an unusual sign. It was homemade, and it wasn’t condemning abortion. Instead, its message was: “Boys are born boys, girls are born girls.”
“Oh, so they’re picking on us for the transgender care, too,” Cathey, director of gender education for Planned Parenthood of Great Plains, recalled thinking.
Arkansas is the only state whose governor has signed into law a bill to restrict healthcare for trans kids, and although that law has been halted by a court challenge, it hasn’t dissuaded a flurry of other states from trying to enact similar laws this year. Texas Gov. Greg Abbott recently went even further: After Texas repeatedly failed to pass legislation that would restrict gender-affirming care, he ordered his state’s child protection agency to investigate the families of trans kids for child abuse. A lawsuit also stopped that order.
But the damage lingers for trans kids, their families, and their doctors, even beyond the borders of Texas. People who offer gender-affirming care for trans youth and adults say they fear increasing harassment and protests. As their work grows ever more politicized, doctors who offer gender-affirming care worry that they’ll become like abortion providers, who have spent decades battling legislative attacks and physical violence.
Health Liberation Now!, a trans-run resource that analyzes the forces targeting gender-affirming healthcare, first recorded a protest of gender-affirming pediatricians in December 2020, in Los Angeles. But over the subsequent months, HLN tracked 15 clinic protests, in cities like Chicago, Philadelphia, Dallas, Salt Lake City, and Seattle. “It’s bad enough when people show up and are targeting specific actors or chanting weird transphobic stuff outside of clinics. That can be very scary and intimidating,” said Ky Schevers, an HLN researcher. “But we’re worried that eventually, it could get way, way worse.”
As their work grows ever more politicized, doctors who offer gender-affirming care worry that they’ll become like abortion providers, who have spent decades battling legislative attacks and physical violence.
Dr. Gina Sequeira said she’s received hate mail and had protesters show up at Seattle Children’s hospital, where she works, twice last fall. The pediatrician spoke out about being a provider of gender-affirming care in a February Time magazine story; afterward, someone tweeted at her, “The only thing you have to fear is the lawsuits.”
“I realized quickly, after the Time piece, that it is very easy to find somebody’s personal information online—far easier than I ever had realized, to be honest,” Sequeira said. She ended up buying a service that deleted online personal information about her. “I felt like those were things I needed to do to protect myself and to protect my family. I think that was pretty chilling. To take a step back and reflect on that a little bit—never did I think, as a pediatrician, that I was gonna be doing work that was controversial to this degree, to the degree that would garner personal threats toward me.”
“I’d heard from colleagues that do abortion care, the lengths that they go to protect themselves,” Sequeira continued. “But never did I think that was something that was gonna be a part of my experience.”
After Gov. Abbott issued his order about trans kids, self-described “gender industry abolitionist” Alix Aharon took to YouTube. In a livestream, she called Abbott’s order “phenomenal” and described Planned Parenthood as “criminals” and “profiteers.” She praised a woman who, she said, “went into a Planned Parenthood” and obtained what Aharon called “evidence”—a flyer of, evidently, meetings for LGBTQ youth between the ages of 12 and 21.
“I would really love it if you were able to attend one of these for me and tell me what it is that they’re actually talking about,” Aharon urged viewers.
Aharon maps out clinics that, she says, provide gender-affirming healthcare; the map’s webpage is labeled “name and shame doctors.” Abortion opponents have done something similar for decades. In the 1990s, they crafted “Wanted” posters for doctors who performed abortions. Today, the anti-abortion organization Operation Rescue runs a website that lists abortion providers’ names, photos, and business addresses. (This information should only be used “to aid in the end of abortion through peaceful, legal means,” a disclaimer proclaims.)
On her YouTube channel, Aharon has posted the audio of a conversation between a woman who appears to pose as the parent of a trans kid and tries to fish for information from someone who seems to work at a clinic that offers gender-affirming care. This interest in infiltrating clinics seems to borrow from anti-abortion tactics, as abortion opponents have secretly recorded themselves talking to Planned Parenthood workers.
The word “abolitionist” also echoes language found within anti-abortion circles, which have a long history of co-opting social justice frameworks. Today, so-called abortion “abolitionist” groups see the mainstream “pro-life” movement as staid and unwilling to do what’s necessary to end the “abortion industry.”
Mainstream anti-trans politicians also seem to be taking cues from the anti-abortion movement. So far this legislative session, at least 19 states have introduced laws that would restrict healthcare for trans youth, according to a tally by the ACLU. Over the course of the entire 2021 legislative session, 21 states did the same. These bills’ rhetoric tends to resemble the worldview embedded in abortion restrictions: Advocates pitch them as necessary limits on healthcare in order to protect women and children, against medical experts’ advice, and the bills frequently propose penalties for the medical professionals who work in this field, rather than the patients. Patients, meanwhile, are often portrayed as victims of predatory medical providers.
These bills often list out what kind of care they would ban, starting with procedures like “castration,” “vasectomy,” “hysterectomy,” and “mastectomy.” The politicians who push these bills also focus on these types of procedures. This may sound scary, but it’s misleading: Minors are not supposed to undergo gender-affirming genital surgery under current medical guidelines. Instead, a child may first socially transition, use reversible puberty blockers for years, and, once they become an older teenager, graduate to potentially using hormone treatments.
“In both abortion work as well as gender care, we have a lot of intrusion from politics and from politicians about what we can and cannot do and how we do it,” said Bhavik Kumar, director of primary and trans care at Planned Parenthood Gulf Coast. This intrusion, he said, creates “this fog of fear and stigma around the care that we’re providing and the patients that we’re taking care of. That also bleeds into stigma with the profession.”
“In both abortion work as well as gender care, we have a lot of intrusion from politics and from politicians about what we can and cannot do and how we do it.”
Kumar has provided gender-affirming care in Texas for almost three years, but he’s also provided abortions for the last seven. (His gender-affirming care patients are over 18.) He’s gotten used to what he called “the background harassment.” Now, colleagues who provide gender-affirming care are looking for help.
“We’ve started to see some folks reach out about harassment or getting concerned about their own safety and their family’s safety,” Kumar said. “My go-to when somebody asks those things is, we’ve already gone through this in abortion care and we have so much that we’ve learned.”
There are roughly 150,000 trans children between the ages of 13 and 17 now living in the United States. Now, thanks to government efforts to curb access to gender-affirming care, more than 58,000 trans children and young adults are at risk of losing access to those services.
Providers worry that putting this kind of political spotlight on gender-affirming care would drive doctors and medical institutions away from offering it in the first place. Major medical organizations such as the American Medical Association, the American Academy of Pediatrics, and the American Psychological Association have all issued guidance supporting gender-affirming healthcare and opposing political efforts to slash access to it. But medical institutions, like institutions of all types, tend to be deeply traditional, hierarchical, and allergic to controversy that could imperil their funding.
Abortion is, once again, perhaps a cautionary tale. Clinics perform 95 percent of all U.S. abortions, while private physicians’ offices and hospitals do just 5 percent, according to a 2019 analysis by the Guttmacher Institute, which studied data on abortions from 2014 through 2017.
About nine months ago, Sequeira interviewed 15 pediatricians across the Pacific Northwest who are interested in providing gender-affirming care. She wanted to know: What’s blocking them from just doing it?
“There were definitely people that were fearful enough to point that they were like, ‘I’m not sure this is something I can take on.’”
“There were many things they identified as barriers, I will be honest,” Sequeira said. “One of them was very clearly fear of political retribution.” One pediatrician worried that offering gender-affirming care would put a “target on her back.” Others said they feared professional blowback, to the point that they could lose their jobs.
“There were definitely people that were fearful enough to point that they were like, ‘I’m not sure this is something I can take on,’” Sequeira continued. “It hurts my heart to think about the impact that has on inhibiting our progress, as it relates to being able to make care more accessible.”
But even without politicians throwing up roadblocks, finding gender-affirming care is certainly not easy. A July review published in the journal JAMA Pediatrics highlighted the numerous obstacles facing trans and nonbinary youth and young adults face when they try to find gender-affirming care. The review, which examined 91 studies involving nearly 900 participants across 17 countries, found that young people dealt with stigma and discrimination in healthcare settings, tangled with insurance and long wait lists, and struggled to find friendly providers. The explosion of Catholic hospitals also threatens access to gender-affirming care, for trans and nonbinary people of all ages.
In 2018, Rhode Island pediatrician and child psychiatrist Dr. Jason Rafferty authored an American Academy of Pediatrics policy statement about supporting trans kids. He told VICE News that he’d received calls and letters from people who called him names and accused him of child abuse.
“With child psychiatrists, there’s not a lot of us. But yet the need is great, especially in some of these states where this legislation is coming up,” Rafferty said. “It may just be a scare tactic, but even loss of a few providers can be really significant in some areas where they are the only ones to go.”
More than half of trans and nonbinary youth seriously considered attempting suicide in the last year, a 2021 Trevor Project survey found. Respecting trans and nonbinary youth’s pronouns and letting them change their legal documents was linked to lower rates of attempted suicide.
At least one other medical institution has not stood by their gender-affirming care programs. Last November, University of Texas Southwestern Medical Center and Children’s Medical Center Dallas dissolved GENECIS, their joint-run program offering care for trans youth. While existing patients can still receive care, officials said at the time, new patients can’t.
Officials initially declined to disclose to the Texas Tribune why, exactly, they shut down the program—considered the first of its kind in the Southwest. But a UT Southwestern spokesperson told the Dallas Morning News this month that “media attention and political and scientific controversy, as well as UT Southwestern’s status as a state agency, were considered in the months leading up to these joint decisions.”
Dr. Ximena Lopez, who formed the program, is now taking UT Southwestern to court over its fate. A petition filed last week alleges that UT Southwestern’s actions potentially expose Lopez to legal liability, “That edict is patently prohibited discrimination. It is illegal,” it reads. “The only question is: Who is dictating this illegal policy and why?”
“Do I feel that there’s been any kind of being picked on for my treating trans patients or abortion patients? Yeah,” Cathey told VICE News. “By the whole medical establishment.”
Emma Ockerman contributed reporting.