January 3, 2024 - 10:00am

What a difference a year can make. In retrospect, 2023 looks like a turning point for the trans movement in the United Kingdom, but could the same happen for the US in 2024? 

The New York Times reported this week that “some of the most contentious issues in the country will dominate the agendas of state legislatures” this year, with debates over gender front and centre. So far, 22 states have banned at least some surgical and/or pharmaceutical interventions for gender-distressed youth — although many of these bans have yet to go into effect. Ongoing legal challenges in multiple states will drag the issue ever closer to the Supreme Court docket. 

The map of the US is starting to look like a patchwork quilt of states where youth transition is banned and self-proclaimed “sanctuary states” which facilitate easy access to transition for youth. Access to puberty blockers, hormones and surgeries will depend on where one lives, with a handful of purple states likely to remain uncommitted in either direction.  

But bans — even bans tied up in litigation —are also messaging devices. While some members of the public will respond in predictably partisan ways, lining up for or against the bans without bothering to size up issues at stake, others will take the opportunity to look closer. Many of those who do will not like what they see. The biggest drivers of public opposition to the trans movement have always been trans activists themselves, in particular their intractability when their demands collide with the interests, needs, and rights of other groups, like women and children. That’s a trend that will only accelerate as public scrutiny increases. 

In the US, public support for key agenda items — access to single-sex spaces and sports, and youth gender transition — is rapidly falling. Pollsters lamented that “general society [is] not willing to allow more rights for transgender people.” Yet what the public seems to be rejecting here are not “more rights” for transgender people, but instead the risks to safety, fairness, and ethical medical practice upon which an unreasonable movement insists. People who are tolerant of difference may baulk at being expected to go along with nonsense. 

Increasingly, it seems as if common sense will ultimately prevail. The sight of a man atop the podium in a women’s cycling race is galling, as is the fact that a troubled teenager who cannot be trusted to get a tattoo is somehow empowered to pick her gender and amputate her breasts. 

Public understanding of trans issues was always something activists explicitly avoided, as a remarkable strategy document revealed several years ago. Instead of focusing on winning hearts and minds by informing and persuading the public, activists preferred to operate behind closed doors — covertly lobbying politicians, piggybacking on more popular causes such as gay marriage and abortion rights, and shunning media scrutiny. 

The US will likely be a lot more litigious than the UK in its approach. From cases brought by detransitioners to female athletes, the courts may end up playing a significant role in changing policy and increasing public awareness of the conflicts gender identity raises around issues like safeguarding vulnerable patients and ensuring fairness in sport. 

There will be plenty of political mudslinging, especially as the presidential primaries kick off in February. Republicans will run on the issue and Democrats will struggle, as so many UK politicians have, to balance the demands of their activist base with the need to not look like lunatics so close to Election Day. 

But perhaps there is a middle way, even in such a divided country. Last week, Ohio Governor Mike DeWine vetoed a bill which would have banned gender transition for minors. Jamie Reed, the whistleblower from the gender clinic at St. Louis Children’s Hospital, reflected that “today could actually be a win if your goals are these: Ending medical transitions in pediatrics AND Adult care that is careful, regulated and requires mental health oversight.” 

Alongside his veto, DeWine announced changes in administrative policy that Reed believes most “reasonable people cannot argue against,” including collecting data on all patients seeking transition and their outcomes, requiring mental healthcare for youth and adults seeking transition, and shutting down providers that do not offer this care.

These moves should help clarify basic facts about the interventions being used and how patients fare over time, two questions which have been critically neglected to date. Then, the public conversation may be shifted from political point-scoring to the cooler terrain of medical ethics and evidence-based inquiry.


Eliza Mondegreen is a graduate student in psychiatry and the author of Writing Behavior on Substack.

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