The People He Needs to Be Hurting
Understanding Ron DeSantis’s crusade against transgender care.
There’s a quote from a 2019 New York Times story that haunts me to this day. The Times reporter was describing the negative economic impacts that President Donald Trump’s government shutdown had on rural towns in the Florida Panhandle. A woman who had voted for Trump told the Times: “He [Trump]’s not hurting the people he needs to be hurting.”
I remembered those words while reflecting on what the Florida Board of Medicine may do soon: severely restrict or ban youth gender-affirming care. Today my son, a transgender boy, is among the “people he needs to be hurting”—though now the “he” is Governor Ron DeSantis, working through his political hack of a surgeon general, Joseph Ladapo.
On October 28, the Florida Boards of Medicine and Osteopathic Medicine are planning to discuss, and probably confirm, guidelines that Ladapo issued in April prohibiting gender-affirming treatments for minors, including social transitioning. Ladapo’s recommendations are part of a broader campaign against transgender care which at times has been motivated by ignorance, zealotry, and rank partisan politics.
Ladapo’s guidelines, which go against current standards of care used by all major medical organizations, are based on cherry-picked and misrepresented evidence as well as the testimony of a few carefully chosen anti-LGBTQ “experts.” Ladapo’s recommendations have already had a chilling effect on Florida hospitals; some have stopped accepting new patients needing care for gender dysphoria in anticipation of coming changes in state law.
The reason Ladapo is seeking to ban youth gender-affirming care is the “lack of conclusive evidence” of its benefits. This is one of the oldest tricks of science deniers. Science—particularly medical and mental health science—is rarely “conclusive” in the sense of absolute certainty that Ladapo is using. Science—again, particularly medical and mental health science—is an ongoing process of managing uncertainties and trade-offs.
Research on gender-affirming care has many uncertainties, but a majority of up-to-date scholarship suggests that it is beneficial. As happens with any other medical treatment, there are potential side effects to puberty blockers—which have been used for decades with no public outrage about it—or hormone treatments that can be assessed and monitored for every person. From what research we have at the moment, their benefits outweigh possible side effects. And there are no negative medical side effects to social transitioning.
A handful of vocal right-wing grifters have been pushing the idea that youth gender-affirming care is some sort of free-for-all, where anything goes and there are no guidelines or best practices and the doctors are all woke activists.
This is not true. Let me tell you what youth gender-affirming care looks like based on my experience as a parent: It is a long, cautious, and individualized process that involves teams of therapists, psychologists, medical doctors, patients, and families. The recent book A Girlhood, by Carolyn Hays, is an excellent primer on what navigating this process looks like, and also on the fears and threats that families of transgender youth often endure.
Regret rates from gender-affirming care are small. There are people who have detransitioned, or wish to do so, and they should receive all the help they need. But the evidence suggests that there are many more people who’d benefit from the care that the Florida Board of Medicine may ban if it adheres to Ladapo’s request. The fact that some people cease or revert treatments is not a reason to deny those treatments to a larger population.
Restricting gender-affirming care would take a broad brush to a complex reality. It would ignore differences between patients. And it would also deprive families of autonomy. I work at the intersection of data and scientific literacy, and I don’t want someone as politically motivated as Joseph Ladapo to dictate what healthcare my family—or any other family—can or cannot access. I’d prefer to rely on actual standards and let families decide for themselves.
This is, after all, what “parents’ rights” is all about.
The problem is that arguing about science, liberty, or autonomy is beside the point. What’s happening in Florida has nothing to do with science; it’s all about fueling political polarization. Ron DeSantis is a man of theoconservative and authoritarian inclinations, as his rhetoric and actions suggest, and he has presidential ambitions. He’s also a keen observer of what his most ardent supporters want, such as the desire to attack those whose existence they find offensive while claiming that they do it for our own good.
Those who support DeSantis's crusade against families with trans kids should beware. History teaches that when you choose leaders to hurt people you hate, they eventually end up hurting the people you love, too.