Can We Stop Calling Trans People Hysterical Now?

How many times must we be proven right?

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This week, the United States Department of Health and Human Services released what they are referring to as a “comprehensive” report, titled “Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices.” 

The 400+ page document, developed pursuant to Executive Order 14187, issued eight days into the second Trump presidency, is beyond unsurprising. Much like the anti-trans memo leaked from Pam Bondi’s office last week, it relies on junk science, rhetorical manipulation, and a mischaracterization of science and diagnostic criteria changes of the past two decades, amongst other harmful concepts. It is essentially a copy-paste of the infamous Cass Report out of the UK, which has been heavily discredited and debunked by scientists and researchers in multiple countries, yet still gets used as evidence to ban best practice medical care for transgender youth. The HHS report was also not actually compiled by medical professionals or scientists – a fact that the report tries to hide by never naming any of its authors and reviewers outright – but by “gender critical” philosophical darling Alex Byrne and two political consultants, as evidenced by examination of the document’s metadata by trans jurist and researcher, Florence Ashley. Now I am the first to advocate for an interdisciplinary approach to transgender rights and existence, but only when the experts in different fields are being appropriately engaged and not giving analysis and recommendations outside of their areas of study. This simply is not the case with the HHS report, which presents itself as a “rigorous” (note the sarcasm) medical and scientific review. This lack of transparency is concerning, as many Americans will not know that the report was not compiled or reviewed by medical professionals and scientific experts, and take it at face value. The report does not carry any force of law, but is presented as a “guide” for parents, medical practitioners, and policy makers moving forward, and will have a major impact across the country.

I don’t want to spend this week’s blog dissecting and debunking the report when others have already done an excellent job doing so. Much of what I would have to say in that regard would be a repeat of my blog on the Bondi memo last week, as unsurprisingly the memo relies on the same claims. I would not be surprised if the AG’s office had received an early copy of this report prior to its public release given the timing and shared rhetoric, though I want to be clear that this is pure speculation on my part. If you want a good, clear breakdown of the report’s core claims, I recommend hopping over to Erin Reed’s work on it, which is well researched and well cited. If you want a biologist’s understanding of the science surrounding trans healthcare, I would also recommend this 2023 essay from Julia Serano, which goes through much of the same material used in the report.

Instead of redoubling the efforts of other writers, I want to take the time to talk about the actual state of trans rights and existence in the United States, the impact this report is going to have, and what we are going to have to anticipate moving forward as we continue to fight this Christo-fascist movement.

When trans advocates like myself ring alarm bells about the rising flood of anti-trans rhetoric, pseudoscience, and policy, we’re frequently told that we’re being “hysterical.” When people started to describe these tactics as “genocidal” we were told that we were exaggerating. When we fought back against those tactics, we were told by much of the mainstream liberal establishment that we needed to shut up, and that we were being too loud and demanding too much too fast. Trans people quickly became the Democratic scapegoat for why Harris lost the 2024 election, despite the fact that polling data says the opposite.

And yet over the past four-odd months we have been proven right, time and time again, that our fears and concerns are well founded. Trump came out the gate immediately with attempts to decimate legal recognition for trans people under the law, including going so far into bed with the Christian right that the administration accidentally defined “woman” in a way that includes all human beings in an attempt to slip in fetal personhood language. Attacks on access to best practice medication, our ability to use public restrooms and locker rooms, our ability to play sports, access passports and other accurate gender identity documents, and beyond have once again increased exponentially nationwide. We’ve once again already broken last year’s anti-trans bill record of 701 anti-trans bills, with 859 anti-trans bills being introduced nationwide this year as of writing. I’ve been tracking this explosion since 2020, and fighting it has been my full time job since 2022. We crossed the boundary line from concerning to terrifying a long time ago.

Now I’ll note, for the sake of temperance, that the overwhelming majority of the bills that have been introduced in the past couple of years have not passed. Only 51 of the 701 bills in 2024 passed, 87 out of 615 in 2023, and 26 out of 174 bills in 2022. But there is a bigger picture here than whether or not bills will pass.

When you see a large flood of bills targeting a single community, regardless of whether they become law, that is indicative of a cultural and political shift in public attitudes, and usually not for the best. Think about the ways that public discourse around trans people has changed in recent years. In May 2014, Time Magazine published an article titled “The Transgender Tipping Point,” featuring trans actress Laverne Cox on the cover. The article is a fascinating time capsule of the mainstream media discussions of the era, with a generally positive air, noting that while there was still a long way to go in the realm of trans rights, health, and safety, there were major steps forward happening. The general vibe was that trans acceptance was officially on the way up, and that we had reached a turning point in history that would lead us to fully normalizing trans existence in a matter of years. Had that article been written today, over a decade later, an article from a mainstream legacy media outlet with the title “The Transgender Tipping Point” would almost certainly feature anti-trans activists railing against how trans people are apparently destroying society, science, sports, and grooming our children to pedophelic ends.

This, of course, has been much of the goal of the groups behind these bills, including but not limited to Christian nationalist outfits Alliance Defending Freedom, the Heritage Foundation, Eagle Forum, amongst others who designed this attack to normalize theocratic politics to the American public. These organizations have been engaged in a significant, coordinated effort to convince even secular thinkers to embrace a conservative biblical understanding of the relationship between sex and gender. Sharing staff, funding, and other resources, the Christian nationalist movement finally found the issue that would most easily let them get into the halls of power for good: trans people.

Let me be clear here: the Christian nationalist movement wants to eliminate trans people. They are not “just asking questions.” If they were, they would not be claiming that just because the bulk of mainstream reputable research on trans health care does not show the kinds of harms that they’re looking for, that means that trans people have “ideologically captured” academia and are stifling dissenting views. Right now, they are actively using three different tactics to pursue their end goal of trans genocide.

First, they want to eliminate trans people via “cures” and “prevention.” They want the public to think that a socio-cultural phenomenon that has existed for as long as humans have had the ability to conceptualize the idea of a “man” or “woman” is a new psychological illness, related to social media, secularism in schools, and the “woke mind virus.” Terms like “Rapid Onset Gender Dysphoria” seek to blame transgender identity on social media, and in particular their belief that girls’ are inherently weak to social pressures, and that trans children can somehow be cured by having their access to trans people cut off. This is demonstrated by the HHS report spending significant space promoting conversion therapy, saying that instead of the gender affirming healthcare model, children should be forced through therapeutic measures to “correct” their self-identity to align with their sex assigned at birth. This is nothing new – conversion therapy measures have always been apart of the conversation, and its practitioners have been increasingly organizing to present their “Judeo-Christian” approaches to gender and gender dysphoria as a legitimate therapeutic alternative to the gender affirming model despite the plentiful evidence that conversion therapy does more harm than good. They also seek to “prevent” transness in youth by banning books, television, movies, and other forms of media that depict trans people as having complete, happy, and fulfilling lives. They want to ban trans people from the classroom or any space where they could conceivably interact with children. Because as we all know you can of course prevent a child from growing up to be gay or trans by merely ensuring they never hear the words or see people like that.

No mainstream medical organization views trans identity as an illness. Gender dysphoria, the diagnosis currently associated with trans identity for clinical purposes, refers to the distress that occurs when your gender identity does not align with your assigned gender at birth. The gender affirming model seeks to alleviate that distress by bringing the social perception of the body in line with the patient’s internal self-perception, in whatever way fits best for that individual patient. Trying to “cure” transgender identity itself is about as effective as trying to “cure” having blue eyes. It’s just a part of human existence.

The second pathway is through institutionalization. If they cannot cure us, they will claim that our “illness” is another label in order to justify limiting our rights to self determination.

This is why you see so much emphasis on testing every trans child for autism and attempts to discredit trans people’s identities by pointing out that some people have co-occurring neurodevelopmental conditions or mental illnesses. None of those things inherently preclude a person from being able to know their gender identity. After all, no one doubts a cis person with a developmental disorder on their gender identity. But we do live in a massively ableist society that infantilizes disabled people to the point of disenfranchisement. It’s true that there seems to be a higher rate of trans identity amongst autistic people, but correlation does not equal causation, and even if autism did make you trans, that would not be enough of a reason to “cure” it.

But that is not in line with the current administration’s approach to autism either. Just look at RFK Jr.’s recent claims that autistic children will never play baseball, write poetry, date, or pay taxes (which if that last one is true the government owes me quite a bit of money and I will be coming to collect.) Now the ability to do any of those things does not determine whether a person is worthy of life and self-determination, and the idea of the “useless eater” being in need of elimination is in fact the rhetoric of the Nazis. But when you frame autism as a disease in need of curing, and transgender identity as a result of autism, the end result will always be institutionalization in psychiatric facilities. Autism, alongside any number of mental health conditions, are already often used to justify adult “guardianships,” completely and totally disenfranchising people who do not fit a neurotypical standard. Part of the goal of this HHS report was to discredit trans people and reduce our perceived ability to define ourselves on our own terms by associating us with other highly stigmatized conditions that often lead to the legal limitation of autonomy, preventing us from making choices for ourselves about our healthcare, and at its most extreme end, removing us from public view.

The third pathway to elimination is incarceration (which is another form of institutionalization, but carries different cultural connotations). Returning to the rhetoric of the anti-trans movement, we see a clear move to criminalize any form of public presentation that might be construed as non-cis and non-straight. Think of how the HHS report was framed earlier this week when it was announced: “Report to the President on Protecting Children from Surgical and Chemical Mutilation Executive Summary.” (Emphasis added.) Using similar language to last week’s Pam Bondi Memo, it is clear that this administration wants the public to view transgender people as a pressing, physical threat to the health, safety, and wellbeing of America’s children. Harm to children is the fastest way to scaremonger a population into criminalizing an entire group of people. This is why we see criminal penalties (as opposed to civil penalties, which would still be bad but are another can of worms) being proposed for healthcare providers who utilize the gender affirming model. This is why we see trans people using the bathroom being characterized as sexual predators and existing while trans in public being labelled as “indecent” or “pornographic” sexual content. This is why we see drag shows, regardless of their actual content, being equated to stripping and sex work. We want to protect our children from sexual content that is developmentally inappropriate, and in the United States and much of the rest of the world our immediate instinct is to jail, or otherwise cause violence to anyone who would harm our children – especially if sex is involved.

This administration is pushing a narrative that will cause the public to view trans people as inherently criminal, even when they’re engaging in perfectly benign behavior. Within the criminal justice system this will lead to higher conviction rates of trans people, regardless of actual guilt, as prosecutors present trans identity as a sign of criminality. And because we view those who cause harm to children as the most dangerous of criminals, trans people will be amongst the “homegrowns” Trump wants to disappear to prisons in El Salvador. 

These pathways also lead to self-policing by trans people, our families, and our healthcare providers. In addition to hopefully gaining public support for institutionalized violence against transgender people, they are hoping that by merely making their opinions clear, they will be able to convince people to go back into the closet or otherwise eliminate themselves from public perception by complying in advance. Again note that the HHS report does not carry the force of law. But it will almost certainly prompt healthcare providers to cease providing gender affirming care well before any legislation is passed out of an abundance of legal caution. It will prompt parents to decline best practice healthcare for their trans youth, either because they believe the junk science being promoted by the government, they fear having their children removed from them on claims of “abuse” and “child mutilation,” or because they feel it is best to attempt to shield their child from the potential legal consequences of transgender identity. And trans people will increasingly consider whether they need to go back into the closet, or never come out at all, electing to suffer through life as a gender identity that is not theirs, or worse, end their lives altogether.

We’re seeing these results in real time already. The 2025 Kantar DIVA Report, which tracks the safety of LGBTQIA+ women and nonbinary people in India, South Africa, the UK, and the US show a drastic decrease in feelings of safety amongst all categories of survey participants. We’re seeing trans websites publish guides for trans people seeking to move to a safer location, in reaction to the hundreds of thousands of trans people and their families that are moving, even within the US, to protect themselves. Just last week, Miss Major, a transgender Stonewall participant and activist, was reportedly turned away from a domestic flight by airport officials until she showed her passport, which still carries an “M” gender marker, even though there are no laws banning someone from flying under an “X” gender marker. And the Trevor Project, a mental health crisis and suicide prevention line for LGBTQIA+ youth has noted an increased volume in calls since the inauguration.

These consequences are happening, and they're happening now. At every turn trans people have been proven right about the risks we are facing. And we will continue to be proven right when they start attacking cis people for not adhering to strict biblical gender roles. We will continue to be right when this administration goes completely and totally mask off on their plans to force women out of the work force and into maternity wards, when they reestablish “cross dressing laws,” and when they arrest people for any kind of nonconformity. And we will not say “I told you so.” We will still keep up the fight, at least, those of us who are still left to fight.

But maybe, just maybe before we get to this point, people could use an ounce of pattern recognition, and start listening to trans people when we warn about the consequences of state policing of gender. It’s not too late. We can roll this back. But it starts with admitting that we were never being hysterical about what we have at stake.

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Kat (they/them) is a queer lawyer, activist, and theorist focusing on the intersections of law, queerness, religion, and politics, with the occasional bit of theology, political theory, and legal theory thrown in for good measure. Originally from rural southern Indiana, Kat earned their B.A. in Political Science in 2019 before continuing on to earn their J.D. in 2022, both from Indiana University- Bloomington. A former Equal Justice Works Fellow for the Freedom From Religion Foundation, Kat has spent their professional career fighting for the separation of church and state and LGBTQIA+ rights. Outside of work you can find them at a ballet or contemporary dance class, sipping on dirty shirleys at their local gay bar, or playing video games with their cat, Merlin.