DEATH BEFORE DETRANSITION
The trans care apocalypse is here. What now?
On Tuesday, January 28, the Trump White House released a new executive order, Protecting Children from Chemical and Surgical Mutilation. The order is extreme, tyrannical, nationwide, and is going to kill people. While titularly targeting health care for adolescents, the text of the order explicitly targets 18-year-old adults, and its impacts on providers are likely to disrupt care for trans patients of all ages. There is no good here.
What does the order do?
Defines “children” as persons under the age of 19, not 18.
Defines chemical mutilation as including deferring puberty with GnRH agonists, the use (in the context of trans health care) of androgens and androgen blockers, estrogen, progesterone, and testosterone.
Defines “surgical mutilation” as “surgical procedures that attempt to transform an individual’s physical appearance to align with an identity that differs from his or her sex or that attempt to alter or remove an individual’s sexual organs to minimize or destroy their natural biological functions.”
Bans the use of research and guidance produced or endorsed by the World Professional Association for Transgender Health, the most experienced and knowledgeable experts in the field.
Mandates a “Cass Review”-style report, with conclusions that are inevitable, given restrictions on WPATH sources.
Denies the existence of trans children though use of language such as “children who assert gender dysphoria, rapid-onset gender dysphoria, or other identity-based confusion.”
Denies coverage for trans-related health care when using government-funded coverage such as federal employee benefit plans, Tricare (health insurance for military service members and their families), and Medicaid.
Bans all funds to institutions or individuals that provide care similar to the treatments prohibited above.
Mandates investigations and enforcement to ensure no entity in the United States provides the banned care, including through use of the female genital mutilation provisions of the criminal code —Title 18 § 116.
Investigates and prosecutes violations of the Food, Drug, and Cosmetic Act, and probably the Deceptive Trade Practices Act.
Mandates the attorney general and Secretary of Health and Human Services to protect “whistleblowers who take action related to ensuring compliance with this order,” such as Eithan Haim, whose indictment for criminal violation of HIPAA was dismissed on Friday.
Utilizes the Parental Kidnapping Prevention Act to disarm “sanctuary state” laws.
Creates a private right of action for patients or their parents to sue care providers.
Damn. That’s a lot.
What does it all mean?
It means that about 40 percent of children who have health insurance will now have plans that forbid coverage of trans-related care. But more than that, it means that care providers will be investigated as aggressively as any theocrat might wish to ensure that no patient is under 19 years of age and that every patient receives whatever the Trump administration eventually decides is information necessary to prevent “misleading the public about long-term side effects of chemical and surgical mutilation.”
While many of the provisions explicitly state that they apply to medical care for persons under the age of 19, the anti-fraud language isn’t limited by age at all. And that is scary as hell.
Since the executive order is active immediately but guidance about what the government considers to be “misleading” information about treatment side effects is not yet available and might not be available for years, any care provider, even gerontologists who only treat trans persons over 90 years of age, is running the risk of heavy fines or even jail time every time they write a prescription or perform surgery.
It is unclear if there will be any physicians in any state or territory who will still be able and willing to write prescription refills next week.
But it’s just trans people, right? Right?
If you’re breathing a sigh of relief that this is only targeting trans people and that means you don’t have to speak up yet, there’s more bad news. The “anti-fraud” efforts — which yours truly warned you about last year when detailing the risks of nominating a whack job as FTC chair — apply to surgical or chemical “mutilation,” which, we should all remember, is defined like so:
procedures that attempt to transform an individual’s physical appearance to align with an identity that differs from his or her sex or that attempt to alter or remove an individual’s sexual organs to minimize or destroy their natural biological functions
Is yr Wonkette crazy or does attempting “to alter or remove an individual’s sexual organs to minimize their natural biological functions” via surgery or chemicals sound exactly like birth control. It sounds especially like birth control when discussing options like Norplant and IUDs, but even your average birth control pill minimizes the “natural biological functions” of the ovaries. Under this executive order, the federal government very much appears to have decided that it’s illegal to provide birth control to persons under 19 years of age, and that even when providing it to persons over 19 it has to be accompanied by information sufficient to prevent “misleading the public” about side effects.
Given that theocrats and Republicans (but I repeat myself) have asserted for decades that the pill and abortion both cause cancer and that Planned Parenthood and your average GP minimize or deny that risk, it’s hard to imagine that this order isn’t going to be used to hound birth control prescribers — at the very least those who prescribe to teens.
So what is this going to do?
Kill people.
No, seriously. There’s a reason that “death before detransition” is a commonly memed phrase in trans communities. There’s a reason that there are multiple songs titled Death Before Detransition (personally I like RIOTNINE’s version, though it’s lo-fi thrash punk that’s probably unlistenable for many folks).
Think of it this way: Banning abortion never ends abortion. It ends safe and legal abortion. Women and other pregnant people die when there is no access to safe abortion. They die because sometimes abortion is life saving care, and they die sometimes when back alley abortions create lethal complications.
Not all trans people seek medical care to alleviate the distress that often results from conflict between trans bodies and trans brains. Some people don’t need it. Others have bigger worries or medical contraindications. The point here is that sometimes it’s important and medically indicated, but it’s not necessary to save a particular person’s life or sanity. Again, not unlike abortion. No one chooses to have an abortion without important reasons, but not every abortion is literally lifesaving.
And yet for some people, trans health care is literally life saving. Or at least sanity saving. And when denied safe, legal access, trans folks will do what they frequently did for decades, what pregnant women have done for centuries: They’ll do for themselves. Some people will find hormones on the bus. Some people will perform surgery on themselves (though perhaps that describes such cutting too generously). Some trans people will perform surgeries on other trans people with no license and little or no training. Others, even more sadly, will kill themselves.
People will be injured. People will die. Because as much as those singing and signing and scrawling death before detransition repeat that this is not a license to suicide, but a call to resist cis hatred of transness and trans people to the very last breath, some won’t have the strength.
This is the trans care apocalypse, and there is no longer any sanctuary.
Your friendly, neighbourhood Crip Dyke also writes other perverted stuff!
You could also follow me on BlueSky. Pretty sure that would make you cool or something.
If you’re breathing a sigh of relief that this is only targeting trans people, we can't be friends.
Forced detransitioning of prisoners, too.