Little blue pills
I’m a little angry about Wednesday’s Supreme Court decision upholding gender affirming care bans. Bear with me while I rant in anguish.
I would like to be able to write about the lovely anniversary trip my wife and I had to Sunriver in central Oregon last weekend. Or how much I look forward to tabling at Trans Pride this coming Friday for our LGBTQ youth community center. Or how proud I am for surviving a very challenging year of academic leadership. Or the many exciting research papers my students, teachers, and postdoc toil away at, trying to make progress on computing, learning and justice.
But I can’t. Because the thing most on my mind is the little blue pills I take twice a day. The ones that saved my life, and continue to each day. The same pills, like the many other forms of gender affirming medication, that save millions of trans lives every day, including children’s.
You see, 27 states in the United States have banned them for minors. Republicans in the House and Senate want to ban them for all adults on Medicare. Some have stated they want to ban them outright for everyone, nationwide. The Supreme Court has decided that they may, because the majority doesn’t believe trans people aren’t being discriminated against, and aren’t particularly vulnerable anyway, because none of the history or present of discrimination against trans people is real. Equal protection under the law, unless you are transgender, they argue.
What the conservative politicians say they fear is our “regret.” They are not transgender, of course, or the parents of trans kids, or the doctors or counselors who care for trans kids, or even remotely expert on anything about trans experiences. And so they don’t actually know what regret is, or what causes it (hint: puberty). Nor do they know what gender affirming medications mean to many trans people. But despite that, they insist that trans people are not in a position to make our own choices about our own bodies, or to face the consequences of our choices. They and they alone must decide on our behalf, because they know better than us, despite having no experience or expertise.
But “regret” is not the true reason why they are banning them. The true reasons are many:
- Some ban them for power. Because the public doesn’t understand trans experiences, nor does it support trans people, it is popular to deny us choice out of ignorance and disgust. These politicians may have their own private viewpoints about trans rights, but forgo them for political gain.
- Sometimes the logic is a Christian one, where being trans but not acting on it is a kind of masochistic devotion to God. You can be trans, just like you can be gay, but God demands you not act upon those feelings, and that all who love God force such a worldview upon all disbelievers through law.
- Sometimes, it’s just cognitive dissonance: if trans people are real, then it means binary, “biological” sex and gender is false, along with all of the other lies built upon it. The gender roles, the gender expression, the unequal rights, and the rest of the white patriarchy that the world is so attached to.
- Sometimes, its myths about the lack of medical evidence, spread by the press and anti-trans governments. Of course, there can’t be sufficient medical evidence: it wouldn’t be medically ethical to deny life saving medication for clinical trials because we have too much evidence already that it saves lives. Moreover, the Trump administration has banned funding for such research, and so even if we wanted to exploit this natural experiment forced upon trans kids to prove the benefits, we can’t.
The reality, of course, is that sex and gender are not binary, and there is plenty of evidence about the value of gender-affirming medical care from surveys, case studies, and longitudinal studies of trans youth. These just aren’t the kinds of evidence that the right wants to accept, because they all require believing what trans people say about their experiences, abandoning patriarchy, and giving up power.
Meanwhile, trans kids and trans adults look to these pills for one thing: relief from a kind of pain that makes some of us want to crawl out of our skin, and sometimes to die. I was in that place many times throughout my youth and adolescence. I managed to distract myself for twenty years, and then when I found myself with a the time to face myself, there was only one truth left: if I didn’t transition, I couldn’t keep living.
I remember the moment that truth became clear. My daughter was with her other mom. My wife was away. I was at the bottom of a bottle, in uncontrollable tears, vomiting in a toilet. I remember wanting to bash my head into the porcelain. There was something about two decades of internalizing the world’s message that I was not and should not be trans that there were only two ways out: die, or accept that they were wrong.
The next morning, I sobered up, and spent three hours trying to write a three sentence email to a therapist in my neighborhood:
I’m looking for a therapist. I need help with some gender troubles and am afraid I might hurt myself. Are you taking new clients?
I remember being so ashamed that it took me that long to get those words out. Here I was, a tenured professor who wrote thousands of words a day. But I couldn’t type those words, because they were too real.
In my first appointment, I mostly cried continuously for an hour. In my second, I managed to get the words out. “I don’t think I’m a man.” A few months later, I was could admit I was a woman without crying. And a few months more, I had sorted out how I had managed to dig such a deep hole. It wasn’t long before I was planning on how to tell my wife and my daughter and making plans to access gender affirming care.
Because, as much as I had learned to not hate that I was trans, every time I had to look in the mirror, there I was in all of my masculine forms. I saw everything I had hated about puberty: the facial hair, the broad shoulders, the ribs, the height, the brow. Every little secondary sexual characteristic that I was unable to stop in my adolescence. Each little change I had fantasized would stop, but never did. My body had betrayed me in my adolescence, and as much as clothing and hair might hide it, little blue pills were my only hope to undo a bit of the damage puberty had done.
And so I found myself at a Kaiser Permanente one afternoon, with one of the region’s experts on gender affirming care. It was surreal being there. Ten years prior, I had illegally bought blue little pills from Vietnam, trying to self medicate. I took them for a couple months, got afraid, and toss them out, then spend another $200 on another batch that I would throw away again. But here I was in an real doctor’s office, about to get them through a legitimate source, for $10 a month. He gave me the informed consent speech. I meekly confirmed I understood that many effects would be irreversible, and that there’s nothing I wanted more. I cried in joy, and after an awkward pause, and he locked eyes and said, “I know you’ve waited a long time for this. And I know how much this will help. You will be okay, you will be strong, and you will be you.” and then handed me the script.
He was right, even if change from estrogen was slow. After a year, I had my little breast buds, and some softer skin. After another year, people started calling me miss and ma’am. I still thought I looked like a man, but my wife, and everyone else around me, started saying otherwise. I eventually caught up to them and saw the woman I was meant to be in the mirror. I was okay, and strong, and me, and I no longer wanted to die.
I’ve watched the same thing happen with trans youth a hundred times. Whether puberty blockers, or hormones, or a gender affirming surgery in their twenties, these little bits of medical care pull youth out of depression and despair, and get them back to living.
These are the life-saving transformations that the right wants to deny us, for power, or because of mis- and disinformation, distrust in trans youth and adults, and Christian animosity for bodily autonomy. There is no legitimate debate to be had: there is only the need for the cis majority to listen to us and believe us. In the absence of that, trans youth across the country are one step closer to the hopelessness that leads them to wanting to die, while trans adults now have to plan for a decade of underground formularies to keep living.
It’s as simple as this: state-mandated puberty and detransition are not freedom. They are not justice. They are state sanctioned oppression, discrimination, and cruelty, and unequal protection in a country that was supposed to protect against the tyranny of the majority for its most vulnerable residents. The people who have created this tragic moment, whether for power, or religion, or ignorance, will have blood on their hands. Meanwhile, trans folks will spend our weekends trying to keep the kids alive, fighting for the basic right to exist, and taking the little blue pills and other medication that make life in a transphobic world a little easier to live.
