Some states are forming public health coalitions, largely in response to Kennedy shredding vaccine recommendations. These groups are issuing vaccine guidance to member states based on science and not Kennedy's ideology. The coalitions may also benefit from hearing from state constituents that people want the coalitions to also follow science on reproductive health and gender affirming care.
Capitalism is an economic system where the means of production is privately owned and laborers are forced to sell their labor for less than its use value to sustain themselves. I don't agree that abolishing capitalism necessarily equals liberty for trans people, but I also know that capitalism is not synonymous with liberty, despite what the Western/American capitalist propaganda machine would have us believe.
"Capitalism is an economic system where the means of production is privately owned and laborers are forced to sell their labor for less than its use value to sustain themselves."
No, liberty and capitalism are the same thing, where people own themselves including their labor, which they can employ only on their own terms or sell to others. Everything but liberty and capitalism is some variety of other people owning you. Every extractive legality we put up with now tilting the playing field to the enrichment of others is not capitalism -- it is all of it the ever more elaborate imposition of government, and no small part of it itself the result of some intervention done to fix what was thought to be unjust.
No, we don't so much -- far too much government in the way.
People are not forced to work 40+ hours a week, but that is what it takes to pay for a modern lifestyle, with things like dentistry and Netflix in existence.
Are you suggesting that dentistry is some kind of superfluous luxury - and not the essential, even life-saving healthcare that it is?
Surely you understand that the choice between homelessness and selling forty hours of your precious life every week is not a choice at all, in the same way that the Godfather's "offer he can't refuse" is not really a choice, either.
If you think what we have now is not capitalism, I shudder to imagine what you might consider "true" capitalism to be. Though I must say, in that regard, you sound like the people who insist that the USSR or Maoist China were not "real" communism - sorry to say it, but although your ideology works well on paper, in reality it always leads to regulatory capture and the construction of a vast police/surveillance state in order to enforce the needs of unfettered capital, which naturally seeks accumulation into fewer and fewer hands. Your "true" capitalism never existed, and never can exist, because capitalism only comes into existence with the existence of a society governed by laws.
Tell me, what part of government do you see as being "in the way" of capitalism: Minimum wage laws? Environmental regulations? OSHA? Taxes? I'd honestly like to know. Because every capitalist society on Earth has always required some level of government intervention, because although the free market is an incredibly powerful force, it can also be corrosive, amoral, and it externalizes costs as much as possible.
If you want truly unfettered capitalism, don't imagine utopia - look to the UK in the early 19th century, a time when the owners of private property were completely unrestrained and, consequently, millions were displaced and found themselves working 60 hour weeks in brutal conditions, including children and the disabled. Those unable to work were imprisoned, as a way to discipline the labor force and ensure a constant supply of cheap labor. While life for the rich became vastly more expansive, the great mass of England's common folk, the descendants of serfs and peasants, actually saw their standards of living decline. Only when the labor movement finally gained traction in the latter half of the 19th century was the great terror of the capitalists finally brought to an end.
You say that in capitalism people own themselves, but that doesn't stand up to scrutiny. It's capitalism, not individualism. It is rule by capital, which demands constant labor at the lowest possible price, and organizes itself to destroy the bargaining power of the common laborer.
Finally, I will end with this assertion: advocacy for the rights of all trans people is ultimately incompatible with the belief that healthcare should only be accessible for those who can afford it.
Please do not take any of this personally. I am trying to stay in the realm of history, philosophy, and political science.
Economics 101 - Capitalism is a system of economics by which a privately owned company produces and sells a product for profit, and by which most profits are usually reinvested in the company as 'capital'. The funding for all functions of these companies is 'capital' provided by the revenue gathered from the production and sale of products and/or services to the supply industry of other commercial companies, the government, or directly to the public end user.
Nowhere in this description does capitalism engender the concept of liberty, describe any particular favor towards a social condition or contract, and is separate from any particular form of government past that which allows it to exist and proliferate.
Your idea of liberty and capitalism as one is flawed and dangerously misguided.
Russia, despite its communist government, had a capitalist economy even though it was an oligarchy - the people of Russia weren't per se forced to consume the oligarch's products, but since only those products approved by the government were available, their choice in selection was slim. At no point did Russia truly have a communist economy - only their social policy was communist, and it was only communist as long as its leaders agreed on the policy and allowed the people to 'own' it.
Please be kind to yourself and engage in some education in these topics before posting something like this, because otherwise you look foolish, or you look suspiciously like a bot implanted in a community to sow discord. Have a grand day.
I will add, if people own stuff, there will be people who will ‘liberate’ others stuff (i.e. “steal”), and this causes a need for law enforcement, a small part of the soft fascism we all live with because it’s a necessity. The tenants of communism do not inherently Include owning others, but does include telling them what they can own. The problem with that is, there is no utopia, and people will take advantage of other people‘s labor but this happens in capitalism too.
Talia, there really is not a need to be so rude to people right out of the gate.
Honey versus vinegar and all that. It betrays your own position when you lead with thistles and thorns. And you clearly know how to argue; why not just let your reasoning take the lead?
So after 20 years of having each others back at work, helping each other through transition and divorce, fascist American Capitalism is what ends our friendship. Fine. I don’t trust yty, never have, never will. I just wish … we were still friends.
I’m surprised you didn’t contact the AMA for clarification, particularly for their stance to bans and non surgical treatment. Their statement didn’t mention non surgical treatment so I assume they still support puberty blockers and hormones and they also didn’t explicitly support banning care even though the NYT framed it that way. So I was really hoping you could get clarification on that…
We are going to have to go back to the work we were doing twenty years ago, telling our stories, sharing rough hewn personal narrative and most especially sharing the stories of those no longer with us because they were killed or killed themselves. We are going to have to bare our souls and re-humanize ourselves.
No cisgender person or group is going to save us.
No Allies are riding in on M-4 Sherman tanks to rescue us from sweeping fascism and eradication.
If we survive it's because we made killing us softly a worse thing to be seen doing in our society than allowing us to live.
It's going to be very difficult.
Many of us will not survive.
This is the best case scenario.
I doubt I die free in my own country. I turn sixty this year; as a Trans woman I've already lived past my expiry and have less to lose than younger people in fighting against the fascist and the feckless, the fearful and the faint.
Allies. Hah.
I remember years ago in the early teens reciting the pros and cons of the arguments for "the third A" inclusion in LGBTQIA+ in its expanded then proposed 17 letter full version sans plus, without dupes. There was so much debate and furor on how to construct the most inclusive and most final initialism for our communities! So much time and energy expended from Taskforce Conference workshops, WebEx planning sessions, community deep canvassing, uncountable survey monkeys, organizational leadership qualtrix polls. Many objected to "allies" included with "asexual" and "agender" on the basis that we haven't always had allies worthy the name and may not always be able to expect them to stand with us.
And they for damned sure don't share our risks.
I laugh now at the waste of it all.
The jackboots coming don't give a damn what we call ourselves. And they aren't just coming for we Trans and gender expansive folks, 47 rightwing orgs have joined together with "Greater Than" to ban same gender marriage in the US, then UK, then the EU.
We will have to expose our suffering and our scars and once again sing for our supper, begging the nice straight cisgender people not to murder and exterminate us just to verify the color of our blood.
I lived through the 80's when so very very many did not. I suppose I can survive this, too.
Erin and community, where specifically can you recommend for us to donate funds to trusted, nonprofit clinics providing gender affirming healthcare to minors? As a community, we could probably donate enough to keep some of those clinics open for awhile - I mean, if we can buy 71,000 boxes of Girl Scout Cookies, it seems like a lot of us can find another $6 - $24 to keep some doors open. Let's continue to rely on each other, while the hospitals and AGs fight it out.
Thank you, Jo! I have just completed my donation to Transhealth.org, which I dedicated to Erin Reed and her platform for helping us act in community. Making the donation was super easy! I encourage us all to treat it like buying a box of Girl Scout Cookies, something important to do because it shows we care about our community.
In the article Erin said the they "have already been routing patients to clinics willing to provide care, often quietly and through word of mouth. Informal and gray-market pathways persist, not because they are ideal, but because political cowardice leaves people with no other choice."
Thank you for the article. Bemoaning it may be cathartic, how do we fight it?
This is being based on their (or maybe just the APS President) taking seriously frauds like Cass, Zucker, Bailey, Littmann, and yes even RFK Jr. There is no evidence backing this up, just none at all.
Per that, and I'd love to confirm it, "All told, 28 detransitioner lawsuits are now in different stages of legal proceedings across the US."
28. That's it! In a nation where the minimum credible estimate of those who have undergone gender affirming surgeries is ~230k, and a plausible estimate for medically assisted transition of some sort for gender dysphoria is ~760k -- after over a decade of Social Conservatives spending tens of millions of dollars on ambulance chasing, and GAC never being immune to malpractice suit in the first place, and no few states beginning the clock ticking for filing a suit from the date of discovery of harm not date of service -- there are only 28 cases.
That by itself dispositively proves the <1% regret rate.
So what is ASPS and AMA really thinking?
Of note, yes, the person who is currently ASPS President has only ever donated to the GOP candidates . . .
"it was shortsighted not to anticipate that such testimony—offered in a blue state—would play into the kind of coordinated blitz now unfolding" <-- I don't even see a way to sign up for notifications from WPATH. They or someone should, I agree, be more proactively getting ahead of things like this. Why did the WPATH not have a statement ready to go as to the unusualness of the circumstance of Varian Fox, and how the rarity of such suits itself speaks to the integrity of the process when actually followed?
So much of the impact of the administration's policies has been small, incremental changes by healthcare organizations and individual professionals that make it harder and harder for us to get care. Conservative lawmakers are largely not the one taking away necessary healthcare services. No one's been prosecuted yet. Most of the problems in care access are created by preemptive compliance.
Just to name a few recent examples from my work as a therapist, I heard through the grapevine yesterday that at a gender-affirming surgeon in my city is now requiring (adult) patients to be in ongoing therapy before and after surgery to address potential regret. In another state, someone I know (again, an adult!) got dropped by their primary care doctor for being trans and on HRT. I'm sure there are a thousand other small changes happening around the country every day that aren't on my radar because I'm not Dr. So-and-So's patient who just got their surgery cancelled or Big Regional Insurance's subscriber whose plan now makes them jump through ten more hoops just to get their hormones. Trans healthcare is being taken apart bit by bit, and right now, it's largely healthcare professionals and organizations doing it.
I remember being dropped by my primary of five years in 2008 when announcing I wanted to begin HRT. Almost twenty years later and here we are again. Progress has been so incremental and painfully slow, our retrograde mobility so rapid.
And I'm not surprised by the capitulation of the AMA, ACS, and WPATH. It was only a matter of time once incomes and livelihoods were threatened.
We may one day VERY soon be surveying the borders and limits of a post-Trans America where forced detransition is defacto and the established norm. We're already over halfway there from a federal perspective and at the mercy of the next GOPSCROTUS ruling. I suspect that it's already planned by the regime for after the midterms, no matter which way they go.
Love your acronym and am adding it to my lexicon! 😄
You touch on what I think is the ultimate root of the intense controversy over medical/surgical care for just one damned percent (!) of the country's 342 million population: GREED.
Greed drives the billionaires to buy the government that enacts laws and policies that protect the wealth of the 1%, which stays in power by keeping the right-wing voter base happy, much of which is influenced by conservative anti-LGBTQ+ religion, which is willfully ignorant of the damage it is causing because they don't personally know and interact meaningfully with the people they are harming.
It is frustrating and demoralizing. Fight greed with your own generosity toward political candidates who can change it, and toward Erin and groups and individuals who fight for trans equality and for desperate trans adults, teens and kids in immediate need.
And come to terms with the truth that this is a long fight that will go on for generations.
The AMA isn’t surprising. People need to remember that fewer than 20% of US physicians are members, largely because its leadership has long skewed further right than most physicians. This is true for most of the professional organizations and is why most physicians aren’t members of their specialty’s organization.
For years I have blamed the american doctors for placing political and religious beliefs above their Hyppocratic Oath to care for every human life without discrimination.... working in a hospital I try to convince doctors and provide them with the study completed by European doctors about the importance and necessary care to transgenders. So disappointed with American medical field... bunch of cowards.
"For decades, medical institutions forced transgender women to socially transition for years before granting access to hormones" -- My understanding was the 'real-life experience requirement' also applies to transgender men and basically to anyone trans. Was my understanding inaccurate?
Indeed. In the late 1960s/early 1970s, we had to present stereotypically female, practically Donna Reed in an A-line and pearls, for months of appointments. We had to convince the doctors we were interested only in men, before they would bless us with the label “true transsexual” and prescribe diethyl Stilbesterol or later, Premarin. By the 1990s all that was needed was a year or less in therapy and some proof of “real life experience” to start HRT. This was formally reduced to a recommendation of only 3 months of therapy or “real life experience” in the 2000s.
I think I ran across the first “informed consent” clinicians around 2012. That was a nice change.
There is no such hard and fast rule, but generally yes a year of living in your preferred gender is required before letters for any surgery are written. Again it is a generality, not a "rule". Also there is no requirement at all anymore for someone who is adult to live as their preferred gender a year before they access HRT, and there never was really any basis for such a rule. For youth, a usual minimum timeframe would be a year on puberty blockers, and year on HRT, and only then possibly surgery offered for youth at least 16 to 17 years old in perfectly straightforward cases. For 15yo, 14yo, 13yo . . . it is terribly unusual for anyone to be offered surgery of any sort at those ages, and there does seem to be an elevated regret rate when it is undertaken. My overall feel for that is that it still does not exceed 5%, but that is quite a bit more than the <1% which is generally typical.
You are correct, this requirement applied to all trans people. Lou Sullivan is a well-known example, famously fighting through the 70s and 80s for the rights of gay trans men to access medical transition because non-heterosexual and/or gender nonconforming trans people were categorically refused this care. In fact, the DSM criteria for GID (when it was first added in the DSM 3) listed "homosexual orientation" as a contradiction to diagnosis—and therefore access to care—because of a belief that there was no such thing as gay trans people.
Cory, the RLE was different for Trans masc and nonbinary folks, or at least not as stringent or gatekeeping. There are multiple reasons:
1. Fewer medicalized treatment options for Trans masc folk early on meant less gatekeeping simply because there was less structure in the process until phalloplasty became more proficient and available. Once options like phalloplasty, metoidioplasty, and scrotoplasty became common, the era of 2 years plus rigid RLE gatekeeping had passed. Before that Trans masc folks had to pursue hysterectomies, breast reductions, and other procedures while presenting as if they were cisgender women. It wasn't easier in the early days for GAC for Trans masc folk before more modern procedures and protocols were developed because what care there was, was intensely dysphoric. Surgeons of the 1980s used to joke about this regarding the availability of Trans female GAC and the dearth of Trans masc care while quipping "it's easier to dig a hole than build a pole". I still feel horror at the cynicism and reductionism exhibited towards us and our bodies.
2. The gatekeeping of HRT and surgery largely missed nonbinary folks. It's assumed that it wouldn't have affected them but that's not true. Sadly even most Trans folks don't know that 40% of nonbinary people seek medical intervention. It took time to develop best practice and protocols for nonbinary people and by then the transition from the old HBIGDA standards to the more modern WPATH SOC had reduced or sidelined RLE requirements (depending on which version in the developmental timeline one examines).
3. Many professionals in the early days did not believe in the existence of nonbinary identities and wouldn't sign off on any GAC. They felt that as AFAB persons had more freedom in crossdressing and experimentation in gender presentation than AMAB persons, they didn't "really need" GAC. They could content themselves with short hair, trousers, and antidepressants. AMAB nonbinary persons however were strongly encouraged to identify as Trans women or as cisgender gay men. It was a horrible time for nonbinary people but not because of RLE requirements. And this is why even today nonbinary erasure still plagues our community and we still need more education for our GAC providers. And this sad state of affairs existed even before the current dystopic era of Trans genocide.
Intersectionality within our community is not a nice to have, it is mission critical for our collective survival. Though as a Trans woman living in a blue island surrounded by an ocean of red, I'm increasingly uncertain of even how to visualize what I believe survival to look like...will I recognize it when I see it?
I hope this provides a small amount of background in answer to the question. I sometimes forget how much history I've witnessed within our community. I fear when many of us are gone our collective history will be, too. I've witnessed the passing of so very many. In this age of erasure and eradication we are reduced to leaving digital petroglyphs like this to communicate the ghosts of our lived experience.
Thank you for such a heartfelt and detailed reply; I really resonate with your concluding paragraphs here. I specifically wasn't sure about multiple years of RLE being required before testosterone, due to both the history of T as a controlled substance and, as you point out, the slower/more obscured development of GAC for trans men beyond "just take T."
I would offer my own nonbinary transition experience to complement especially on your point #2 about gatekeeping impact not missing us, particularly when we deviate from transnormative pathways and sequencing: 1 year RLE was required of me in 2011, in California. My student health insurance liaison and the LGBT Center community counselor spent hours arguing with the insurance company about details like what counted as living as nonbinary; I was very nearly forced to take testosterone to qualify for mastectomy, and backing out as wrong for me delayed my surgery date to post-graduation, at risk of not happening. My "specialized gender therapist" refused to either use my pronouns or to only use my name in the letter to the insurance about satisfying 1+ year of RLE and counseling. There was no visible possibility of bottom surgery (even hysterectomy, because of risk of regret of not birthing children) without testosterone & metoidoplasty or phalloplasty, despite seeking actively through multiple local, state, and national trans & eunuch & childfree groups, events, and specialist doctors, both in-person and online. Only by chance did I find out in 2014 that vaginectomy exists and doesn't require testosterone (and will get you a hysterectomy); I presented to a specialist center for treatment with letters in hand, and was delayed across multiple visits and coerced into an additional procedure I've since learned was both probably unnecessary and may have been because I had an intersex variation without knowing and without ever being told.
I share this to leave another trace of history, and to uplift your correct assertion that intersectionality is mission critical. Our survival is so entwined with reproductive justice and bodily autonomy. It is intentional, targeted cruelty to readily offer & impose procedures on intersex folks and sex-nonconforming traits (eg gynecomastia & hirsutism from PCOS as obviously innately distressing, thus needing treatment prescribed with no explanation by the doctors that it's even hormones/birth control), to require sterilization for gender recognition & to secretly sterilize immigrants and incarcerated people, all while gating these same procedures from actual consent. It is cowardice around liability combined with callousness toward the disempowered, precisely as Erin argues so well in this article.
As an ally and physician I am deeply troubled by this news. I do believe we’re going to have a grand reset/reframe after the midterm elections. Please hang in there everyone and don’t despair.
This has some quotes from the AMA's official psychiatry journal in 1966:
"9% of psychiatrists, 6% of GPs, and 3% of surgeons would have approved gender-confirmation surgery. Such patients were considered “severely neurotic” by over 80% (86% of surgeons). Other characterizations from surgeons: “morally depraved” (14%); “a threat to society” (19%); “needing institutionalization” (11%)."
The medical establishment was moving (slowly) away from that era, but it is not dominated by progressive thinkers. What I say in the post remains true: getting lived experience to the public is the only way to success. Bigots will always be bigots, but there is a large fraction of the public that simply doesn't know. And social media posts will not reach them; real information, presented with academic rigor or creative expression, is imperative.
Jayna, I agree completely. I believe we need to reach back to the roots of Trans activism and tell our stories. Personal narrative and shared lived experience change opinions and in time, minds. Or at least, it can for those who aren't empathy-impaired.
Thanks! I do believe there are those who still have a vestige of humanity in them even if they've followed "false prophets" as it were.
I could point to many more-prominent authors, but my own experience has its own power. My HS graduating class (1966) would not have been marked for becoming a hallmark of liberal thought, based just on the demographics. But when I first reconnected with them 40 years later, I found a whole lot of open minds, even among the assholes of yesteryear. And today, one of the more politically and socially conservative (actually one year away from my class, the wife of a classmate) is a solid supporter. A beautiful (in more ways than one!) example; there are others.
Many are beyond hope. But so many are not. May the spirit of the universe grant us the wisdom to know and realize the difference, and keep on reaching out where it makes sense. (Nancy Mace needn't apply 😏)
(By the way: I have to do my sales pitch, even if it's not my natural style: a "like" on that Substack post helps me get more reach. 🙂 And if you haven't read the novel: I'll give you a money-back guarantee on it!)
Curious, it almost seems as though they're burning the medical books.
Anyone who has access to an academic database, something you can do in response to this is to save as much information about trans healthcare and psychological care from the past two decades as you can
I suggest you read again. The case of Varian Fox seems to be inarguably an example of actual malpractice -- the therapist and surgeon doing it wrong.
Literally the therapist in their letter endorsing surgery apparently called it "gender dysmorphia" and not gender dysphoria, and the therapist had no training in gender related care.
I agree WPATH needs to be making the effort to get ahead of the political process, and I see no sign they are doing so or even perceive the need for it.
Some states are forming public health coalitions, largely in response to Kennedy shredding vaccine recommendations. These groups are issuing vaccine guidance to member states based on science and not Kennedy's ideology. The coalitions may also benefit from hearing from state constituents that people want the coalitions to also follow science on reproductive health and gender affirming care.
The only way Trans people are going to get our rights is if we get rid of the Capitalist System Of Government and we become HUMAN BEINGS AGAIN! 👿🖕🏽🔥
No, capitalism is liberty itself, if you have one you have the other. The last thing we want is to be the inconvenient property of government.
Capitalism is an economic system where the means of production is privately owned and laborers are forced to sell their labor for less than its use value to sustain themselves. I don't agree that abolishing capitalism necessarily equals liberty for trans people, but I also know that capitalism is not synonymous with liberty, despite what the Western/American capitalist propaganda machine would have us believe.
"Capitalism is an economic system where the means of production is privately owned and laborers are forced to sell their labor for less than its use value to sustain themselves."
No, liberty and capitalism are the same thing, where people own themselves including their labor, which they can employ only on their own terms or sell to others. Everything but liberty and capitalism is some variety of other people owning you. Every extractive legality we put up with now tilting the playing field to the enrichment of others is not capitalism -- it is all of it the ever more elaborate imposition of government, and no small part of it itself the result of some intervention done to fix what was thought to be unjust.
I don't even know what to say except maybe study what you're talking about, like I actually have.
I don’t know Talia. We definitely have capitalism. But I’m not so sure we have the liberty.
In fact, I’d argue that so long as people are forced to work 40+ hours per week just to afford basic food and shelter, none of us are really free.
"We definitely have capitalism"
No, we don't so much -- far too much government in the way.
People are not forced to work 40+ hours a week, but that is what it takes to pay for a modern lifestyle, with things like dentistry and Netflix in existence.
Are you suggesting that dentistry is some kind of superfluous luxury - and not the essential, even life-saving healthcare that it is?
Surely you understand that the choice between homelessness and selling forty hours of your precious life every week is not a choice at all, in the same way that the Godfather's "offer he can't refuse" is not really a choice, either.
If you think what we have now is not capitalism, I shudder to imagine what you might consider "true" capitalism to be. Though I must say, in that regard, you sound like the people who insist that the USSR or Maoist China were not "real" communism - sorry to say it, but although your ideology works well on paper, in reality it always leads to regulatory capture and the construction of a vast police/surveillance state in order to enforce the needs of unfettered capital, which naturally seeks accumulation into fewer and fewer hands. Your "true" capitalism never existed, and never can exist, because capitalism only comes into existence with the existence of a society governed by laws.
Tell me, what part of government do you see as being "in the way" of capitalism: Minimum wage laws? Environmental regulations? OSHA? Taxes? I'd honestly like to know. Because every capitalist society on Earth has always required some level of government intervention, because although the free market is an incredibly powerful force, it can also be corrosive, amoral, and it externalizes costs as much as possible.
If you want truly unfettered capitalism, don't imagine utopia - look to the UK in the early 19th century, a time when the owners of private property were completely unrestrained and, consequently, millions were displaced and found themselves working 60 hour weeks in brutal conditions, including children and the disabled. Those unable to work were imprisoned, as a way to discipline the labor force and ensure a constant supply of cheap labor. While life for the rich became vastly more expansive, the great mass of England's common folk, the descendants of serfs and peasants, actually saw their standards of living decline. Only when the labor movement finally gained traction in the latter half of the 19th century was the great terror of the capitalists finally brought to an end.
You say that in capitalism people own themselves, but that doesn't stand up to scrutiny. It's capitalism, not individualism. It is rule by capital, which demands constant labor at the lowest possible price, and organizes itself to destroy the bargaining power of the common laborer.
Finally, I will end with this assertion: advocacy for the rights of all trans people is ultimately incompatible with the belief that healthcare should only be accessible for those who can afford it.
Please do not take any of this personally. I am trying to stay in the realm of history, philosophy, and political science.
Those two things absolutely do not equate.
Economics 101 - Capitalism is a system of economics by which a privately owned company produces and sells a product for profit, and by which most profits are usually reinvested in the company as 'capital'. The funding for all functions of these companies is 'capital' provided by the revenue gathered from the production and sale of products and/or services to the supply industry of other commercial companies, the government, or directly to the public end user.
Nowhere in this description does capitalism engender the concept of liberty, describe any particular favor towards a social condition or contract, and is separate from any particular form of government past that which allows it to exist and proliferate.
Your idea of liberty and capitalism as one is flawed and dangerously misguided.
Russia, despite its communist government, had a capitalist economy even though it was an oligarchy - the people of Russia weren't per se forced to consume the oligarch's products, but since only those products approved by the government were available, their choice in selection was slim. At no point did Russia truly have a communist economy - only their social policy was communist, and it was only communist as long as its leaders agreed on the policy and allowed the people to 'own' it.
Please be kind to yourself and engage in some education in these topics before posting something like this, because otherwise you look foolish, or you look suspiciously like a bot implanted in a community to sow discord. Have a grand day.
I will add, if people own stuff, there will be people who will ‘liberate’ others stuff (i.e. “steal”), and this causes a need for law enforcement, a small part of the soft fascism we all live with because it’s a necessity. The tenants of communism do not inherently Include owning others, but does include telling them what they can own. The problem with that is, there is no utopia, and people will take advantage of other people‘s labor but this happens in capitalism too.
Capitalism cannot survive without fascism, the choice is, hard or soft.
To hell with you Jenn. Either people own themselves, or the government does.
The first is liberty which is capitalism, or the second which is communism.
Talia, there really is not a need to be so rude to people right out of the gate.
Honey versus vinegar and all that. It betrays your own position when you lead with thistles and thorns. And you clearly know how to argue; why not just let your reasoning take the lead?
Thank you. This is beneath my dignity. All power to the people.
I know Jenn. She can f--k off with her nonsense.
So after 20 years of having each others back at work, helping each other through transition and divorce, fascist American Capitalism is what ends our friendship. Fine. I don’t trust yty, never have, never will. I just wish … we were still friends.
I’m surprised you didn’t contact the AMA for clarification, particularly for their stance to bans and non surgical treatment. Their statement didn’t mention non surgical treatment so I assume they still support puberty blockers and hormones and they also didn’t explicitly support banning care even though the NYT framed it that way. So I was really hoping you could get clarification on that…
We are abandoned.
We are going to have to go back to the work we were doing twenty years ago, telling our stories, sharing rough hewn personal narrative and most especially sharing the stories of those no longer with us because they were killed or killed themselves. We are going to have to bare our souls and re-humanize ourselves.
No cisgender person or group is going to save us.
No Allies are riding in on M-4 Sherman tanks to rescue us from sweeping fascism and eradication.
If we survive it's because we made killing us softly a worse thing to be seen doing in our society than allowing us to live.
It's going to be very difficult.
Many of us will not survive.
This is the best case scenario.
I doubt I die free in my own country. I turn sixty this year; as a Trans woman I've already lived past my expiry and have less to lose than younger people in fighting against the fascist and the feckless, the fearful and the faint.
Allies. Hah.
I remember years ago in the early teens reciting the pros and cons of the arguments for "the third A" inclusion in LGBTQIA+ in its expanded then proposed 17 letter full version sans plus, without dupes. There was so much debate and furor on how to construct the most inclusive and most final initialism for our communities! So much time and energy expended from Taskforce Conference workshops, WebEx planning sessions, community deep canvassing, uncountable survey monkeys, organizational leadership qualtrix polls. Many objected to "allies" included with "asexual" and "agender" on the basis that we haven't always had allies worthy the name and may not always be able to expect them to stand with us.
And they for damned sure don't share our risks.
I laugh now at the waste of it all.
The jackboots coming don't give a damn what we call ourselves. And they aren't just coming for we Trans and gender expansive folks, 47 rightwing orgs have joined together with "Greater Than" to ban same gender marriage in the US, then UK, then the EU.
We will have to expose our suffering and our scars and once again sing for our supper, begging the nice straight cisgender people not to murder and exterminate us just to verify the color of our blood.
I lived through the 80's when so very very many did not. I suppose I can survive this, too.
Bon chance, mi famille en l'tragedie de vie.
This is beautiful </3
Thank you, Iris. Sometimes I bleed words and cry onto the page instead of down my face when stabbed by life. I appreciate the feedback.
Erin and community, where specifically can you recommend for us to donate funds to trusted, nonprofit clinics providing gender affirming healthcare to minors? As a community, we could probably donate enough to keep some of those clinics open for awhile - I mean, if we can buy 71,000 boxes of Girl Scout Cookies, it seems like a lot of us can find another $6 - $24 to keep some doors open. Let's continue to rely on each other, while the hospitals and AGs fight it out.
www.transhealth.org
Thank you, Jo! I have just completed my donation to Transhealth.org, which I dedicated to Erin Reed and her platform for helping us act in community. Making the donation was super easy! I encourage us all to treat it like buying a box of Girl Scout Cookies, something important to do because it shows we care about our community.
Also the Trans Youth Emergency Project (run by Southern Equality)
https://southernequality.org/tyep/
In the article Erin said the they "have already been routing patients to clinics willing to provide care, often quietly and through word of mouth. Informal and gray-market pathways persist, not because they are ideal, but because political cowardice leaves people with no other choice."
I will check them out for next month's donation. Thank you for the recommendation!
Thank you for the article. Bemoaning it may be cathartic, how do we fight it?
This is being based on their (or maybe just the APS President) taking seriously frauds like Cass, Zucker, Bailey, Littmann, and yes even RFK Jr. There is no evidence backing this up, just none at all.
https://nypost.com/2026/01/31/us-news/detransitioner-wins-2-million-against-new-york-docs-who-pushed-double-mastectomy/
Per that, and I'd love to confirm it, "All told, 28 detransitioner lawsuits are now in different stages of legal proceedings across the US."
28. That's it! In a nation where the minimum credible estimate of those who have undergone gender affirming surgeries is ~230k, and a plausible estimate for medically assisted transition of some sort for gender dysphoria is ~760k -- after over a decade of Social Conservatives spending tens of millions of dollars on ambulance chasing, and GAC never being immune to malpractice suit in the first place, and no few states beginning the clock ticking for filing a suit from the date of discovery of harm not date of service -- there are only 28 cases.
That by itself dispositively proves the <1% regret rate.
So what is ASPS and AMA really thinking?
Of note, yes, the person who is currently ASPS President has only ever donated to the GOP candidates . . .
"it was shortsighted not to anticipate that such testimony—offered in a blue state—would play into the kind of coordinated blitz now unfolding" <-- I don't even see a way to sign up for notifications from WPATH. They or someone should, I agree, be more proactively getting ahead of things like this. Why did the WPATH not have a statement ready to go as to the unusualness of the circumstance of Varian Fox, and how the rarity of such suits itself speaks to the integrity of the process when actually followed?
I too commented on WPATH below. <3
Being treated as expendable gets old
So much of the impact of the administration's policies has been small, incremental changes by healthcare organizations and individual professionals that make it harder and harder for us to get care. Conservative lawmakers are largely not the one taking away necessary healthcare services. No one's been prosecuted yet. Most of the problems in care access are created by preemptive compliance.
Just to name a few recent examples from my work as a therapist, I heard through the grapevine yesterday that at a gender-affirming surgeon in my city is now requiring (adult) patients to be in ongoing therapy before and after surgery to address potential regret. In another state, someone I know (again, an adult!) got dropped by their primary care doctor for being trans and on HRT. I'm sure there are a thousand other small changes happening around the country every day that aren't on my radar because I'm not Dr. So-and-So's patient who just got their surgery cancelled or Big Regional Insurance's subscriber whose plan now makes them jump through ten more hoops just to get their hormones. Trans healthcare is being taken apart bit by bit, and right now, it's largely healthcare professionals and organizations doing it.
I remember being dropped by my primary of five years in 2008 when announcing I wanted to begin HRT. Almost twenty years later and here we are again. Progress has been so incremental and painfully slow, our retrograde mobility so rapid.
And I'm not surprised by the capitulation of the AMA, ACS, and WPATH. It was only a matter of time once incomes and livelihoods were threatened.
We may one day VERY soon be surveying the borders and limits of a post-Trans America where forced detransition is defacto and the established norm. We're already over halfway there from a federal perspective and at the mercy of the next GOPSCROTUS ruling. I suspect that it's already planned by the regime for after the midterms, no matter which way they go.
Love your acronym and am adding it to my lexicon! 😄
You touch on what I think is the ultimate root of the intense controversy over medical/surgical care for just one damned percent (!) of the country's 342 million population: GREED.
Greed drives the billionaires to buy the government that enacts laws and policies that protect the wealth of the 1%, which stays in power by keeping the right-wing voter base happy, much of which is influenced by conservative anti-LGBTQ+ religion, which is willfully ignorant of the damage it is causing because they don't personally know and interact meaningfully with the people they are harming.
It is frustrating and demoralizing. Fight greed with your own generosity toward political candidates who can change it, and toward Erin and groups and individuals who fight for trans equality and for desperate trans adults, teens and kids in immediate need.
And come to terms with the truth that this is a long fight that will go on for generations.
The AMA isn’t surprising. People need to remember that fewer than 20% of US physicians are members, largely because its leadership has long skewed further right than most physicians. This is true for most of the professional organizations and is why most physicians aren’t members of their specialty’s organization.
Someone needs to press these cowards on whether or not they still consider it acceptable to perform surgery on minor cis boys with gynecomastia.
For years I have blamed the american doctors for placing political and religious beliefs above their Hyppocratic Oath to care for every human life without discrimination.... working in a hospital I try to convince doctors and provide them with the study completed by European doctors about the importance and necessary care to transgenders. So disappointed with American medical field... bunch of cowards.
"For decades, medical institutions forced transgender women to socially transition for years before granting access to hormones" -- My understanding was the 'real-life experience requirement' also applies to transgender men and basically to anyone trans. Was my understanding inaccurate?
Indeed. In the late 1960s/early 1970s, we had to present stereotypically female, practically Donna Reed in an A-line and pearls, for months of appointments. We had to convince the doctors we were interested only in men, before they would bless us with the label “true transsexual” and prescribe diethyl Stilbesterol or later, Premarin. By the 1990s all that was needed was a year or less in therapy and some proof of “real life experience” to start HRT. This was formally reduced to a recommendation of only 3 months of therapy or “real life experience” in the 2000s.
I think I ran across the first “informed consent” clinicians around 2012. That was a nice change.
I remember the old HBIGDA standards. No lesbian Trans women allowed! God help you if you went to an appointment wearing trousers!
There is no such hard and fast rule, but generally yes a year of living in your preferred gender is required before letters for any surgery are written. Again it is a generality, not a "rule". Also there is no requirement at all anymore for someone who is adult to live as their preferred gender a year before they access HRT, and there never was really any basis for such a rule. For youth, a usual minimum timeframe would be a year on puberty blockers, and year on HRT, and only then possibly surgery offered for youth at least 16 to 17 years old in perfectly straightforward cases. For 15yo, 14yo, 13yo . . . it is terribly unusual for anyone to be offered surgery of any sort at those ages, and there does seem to be an elevated regret rate when it is undertaken. My overall feel for that is that it still does not exceed 5%, but that is quite a bit more than the <1% which is generally typical.
You are correct, this requirement applied to all trans people. Lou Sullivan is a well-known example, famously fighting through the 70s and 80s for the rights of gay trans men to access medical transition because non-heterosexual and/or gender nonconforming trans people were categorically refused this care. In fact, the DSM criteria for GID (when it was first added in the DSM 3) listed "homosexual orientation" as a contradiction to diagnosis—and therefore access to care—because of a belief that there was no such thing as gay trans people.
Cory, the RLE was different for Trans masc and nonbinary folks, or at least not as stringent or gatekeeping. There are multiple reasons:
1. Fewer medicalized treatment options for Trans masc folk early on meant less gatekeeping simply because there was less structure in the process until phalloplasty became more proficient and available. Once options like phalloplasty, metoidioplasty, and scrotoplasty became common, the era of 2 years plus rigid RLE gatekeeping had passed. Before that Trans masc folks had to pursue hysterectomies, breast reductions, and other procedures while presenting as if they were cisgender women. It wasn't easier in the early days for GAC for Trans masc folk before more modern procedures and protocols were developed because what care there was, was intensely dysphoric. Surgeons of the 1980s used to joke about this regarding the availability of Trans female GAC and the dearth of Trans masc care while quipping "it's easier to dig a hole than build a pole". I still feel horror at the cynicism and reductionism exhibited towards us and our bodies.
2. The gatekeeping of HRT and surgery largely missed nonbinary folks. It's assumed that it wouldn't have affected them but that's not true. Sadly even most Trans folks don't know that 40% of nonbinary people seek medical intervention. It took time to develop best practice and protocols for nonbinary people and by then the transition from the old HBIGDA standards to the more modern WPATH SOC had reduced or sidelined RLE requirements (depending on which version in the developmental timeline one examines).
3. Many professionals in the early days did not believe in the existence of nonbinary identities and wouldn't sign off on any GAC. They felt that as AFAB persons had more freedom in crossdressing and experimentation in gender presentation than AMAB persons, they didn't "really need" GAC. They could content themselves with short hair, trousers, and antidepressants. AMAB nonbinary persons however were strongly encouraged to identify as Trans women or as cisgender gay men. It was a horrible time for nonbinary people but not because of RLE requirements. And this is why even today nonbinary erasure still plagues our community and we still need more education for our GAC providers. And this sad state of affairs existed even before the current dystopic era of Trans genocide.
Intersectionality within our community is not a nice to have, it is mission critical for our collective survival. Though as a Trans woman living in a blue island surrounded by an ocean of red, I'm increasingly uncertain of even how to visualize what I believe survival to look like...will I recognize it when I see it?
I hope this provides a small amount of background in answer to the question. I sometimes forget how much history I've witnessed within our community. I fear when many of us are gone our collective history will be, too. I've witnessed the passing of so very many. In this age of erasure and eradication we are reduced to leaving digital petroglyphs like this to communicate the ghosts of our lived experience.
Thank you for such a heartfelt and detailed reply; I really resonate with your concluding paragraphs here. I specifically wasn't sure about multiple years of RLE being required before testosterone, due to both the history of T as a controlled substance and, as you point out, the slower/more obscured development of GAC for trans men beyond "just take T."
I would offer my own nonbinary transition experience to complement especially on your point #2 about gatekeeping impact not missing us, particularly when we deviate from transnormative pathways and sequencing: 1 year RLE was required of me in 2011, in California. My student health insurance liaison and the LGBT Center community counselor spent hours arguing with the insurance company about details like what counted as living as nonbinary; I was very nearly forced to take testosterone to qualify for mastectomy, and backing out as wrong for me delayed my surgery date to post-graduation, at risk of not happening. My "specialized gender therapist" refused to either use my pronouns or to only use my name in the letter to the insurance about satisfying 1+ year of RLE and counseling. There was no visible possibility of bottom surgery (even hysterectomy, because of risk of regret of not birthing children) without testosterone & metoidoplasty or phalloplasty, despite seeking actively through multiple local, state, and national trans & eunuch & childfree groups, events, and specialist doctors, both in-person and online. Only by chance did I find out in 2014 that vaginectomy exists and doesn't require testosterone (and will get you a hysterectomy); I presented to a specialist center for treatment with letters in hand, and was delayed across multiple visits and coerced into an additional procedure I've since learned was both probably unnecessary and may have been because I had an intersex variation without knowing and without ever being told.
I share this to leave another trace of history, and to uplift your correct assertion that intersectionality is mission critical. Our survival is so entwined with reproductive justice and bodily autonomy. It is intentional, targeted cruelty to readily offer & impose procedures on intersex folks and sex-nonconforming traits (eg gynecomastia & hirsutism from PCOS as obviously innately distressing, thus needing treatment prescribed with no explanation by the doctors that it's even hormones/birth control), to require sterilization for gender recognition & to secretly sterilize immigrants and incarcerated people, all while gating these same procedures from actual consent. It is cowardice around liability combined with callousness toward the disempowered, precisely as Erin argues so well in this article.
As an ally and physician I am deeply troubled by this news. I do believe we’re going to have a grand reset/reframe after the midterm elections. Please hang in there everyone and don’t despair.
“When I breathe, I hope”
For the younger readers, I'd like to refer to a post from nearly a year ago (when I got started on this platform!):
https://jaynasheats.substack.com/p/of-history-and-herstory-and-their
This has some quotes from the AMA's official psychiatry journal in 1966:
"9% of psychiatrists, 6% of GPs, and 3% of surgeons would have approved gender-confirmation surgery. Such patients were considered “severely neurotic” by over 80% (86% of surgeons). Other characterizations from surgeons: “morally depraved” (14%); “a threat to society” (19%); “needing institutionalization” (11%)."
The medical establishment was moving (slowly) away from that era, but it is not dominated by progressive thinkers. What I say in the post remains true: getting lived experience to the public is the only way to success. Bigots will always be bigots, but there is a large fraction of the public that simply doesn't know. And social media posts will not reach them; real information, presented with academic rigor or creative expression, is imperative.
Jayna, I agree completely. I believe we need to reach back to the roots of Trans activism and tell our stories. Personal narrative and shared lived experience change opinions and in time, minds. Or at least, it can for those who aren't empathy-impaired.
Thanks! I do believe there are those who still have a vestige of humanity in them even if they've followed "false prophets" as it were.
I could point to many more-prominent authors, but my own experience has its own power. My HS graduating class (1966) would not have been marked for becoming a hallmark of liberal thought, based just on the demographics. But when I first reconnected with them 40 years later, I found a whole lot of open minds, even among the assholes of yesteryear. And today, one of the more politically and socially conservative (actually one year away from my class, the wife of a classmate) is a solid supporter. A beautiful (in more ways than one!) example; there are others.
Many are beyond hope. But so many are not. May the spirit of the universe grant us the wisdom to know and realize the difference, and keep on reaching out where it makes sense. (Nancy Mace needn't apply 😏)
(By the way: I have to do my sales pitch, even if it's not my natural style: a "like" on that Substack post helps me get more reach. 🙂 And if you haven't read the novel: I'll give you a money-back guarantee on it!)
Curious, it almost seems as though they're burning the medical books.
Anyone who has access to an academic database, something you can do in response to this is to save as much information about trans healthcare and psychological care from the past two decades as you can
I think a lot about Magnus Hirschfeld's Berlin Institute für Sexualische Wissenschaft and 1933 these days.
Even WPATH was captured I see. It's gonna be decades before we ever have rights again.
"Even WPATH was captured I see."
I suggest you read again. The case of Varian Fox seems to be inarguably an example of actual malpractice -- the therapist and surgeon doing it wrong.
Literally the therapist in their letter endorsing surgery apparently called it "gender dysmorphia" and not gender dysphoria, and the therapist had no training in gender related care.
I agree WPATH needs to be making the effort to get ahead of the political process, and I see no sign they are doing so or even perceive the need for it.
WPATH has been a gold standard. Why are they silent? They hold much of the real science done in the last 50 years.
You know why. Trump is arresting people on bogus charges, he will do the same to US WPATH members without hesitation.
Ah alright. The wording was a little confusing, so it looked like the head of WPATH had started condemning trans care.