EARLIER THIS MONTH, the administration of Florida Governor Ron DeSantis wrote to 12 state universities, ordering them to provide a list of how many students, of what ages, had sought or received gender-reassignment treatment through their schools’ medical services. The request was strikingly detailed, specifically asking, item by item, about puberty blockers, hormone treatments, mastectomies, breast augmentations, orchiectomies, penectomies, vaginoplasties, hysterectomies, metoidioplasties, vaginectomies, salpingo-oophorectomies, phalloplasties, scrotoplasties, or “any other medical procedure.”
This official inquiry into the intimate anatomy of young people struck a now-familiar tone—the combination of meticulousness and prurience, the performance of rigor.
On January 23, a few days after the news of DeSantis’ inquiry broke, the New York Times published a story under the headline “Parents and Schools Clash on Gender Identity,” at the top of its front page. “For this article,” an introductory note read, the reporter “interviewed more than 50 people, including parents and their children, public school officials, medical professionals and lawyers for both L.G.B.T.Q. and conservative advocacy groups.”
The specific clash about gender identity, in this case, was over the question of whether schools should tell parents that their children have chosen to take on a new gender identity socially, at school, if the children don’t want the parents to know. Following broad, existing principles about student autonomy, privacy, and pupil safety, many school districts honor such children’s preferences. The Times described this situation as an example of “wrenching new tensions over how to accommodate transgender children,” and as something that leaves parents “unsettled” or feeling “villainized.”
The story began with an account of a teenager in California who had socially transitioned from female to male at public high school, at age 15, without informing his parents. The school had not told the parents either, because the teen said he did not want his parents told. The teen’s mother told the Times reporter that “she resented the fact that the school had made her feel like a bad parent for wondering whether educators had put her teenager, a minor, on a path the school wasn’t qualified to oversee.”
The Times also reported, of the teen, that “[d]octors had previously diagnosed him as being on the autism spectrum, as well as with attention deficit hyperactivity disorder, PTSD and anxiety.” This medical history was shared with the readers of the New York Times to illustrate what his parents considered the “complexities” of the case.
There have been many, many complexities in the Times‘ coverage of transgender youth—so many complexities that, when they’re taken together, they start to look like something straightforward. The online version of the story carried an inset box, linking to other Times coverage of the subject the box’s headline called “On Being Transgender in America”:
• Feeling Unsafe: Intimidation and violence against gay and transgender Americans has spread this year—driven heavily, extremism experts say, by increasingly inflammatory political messaging.
• Puberty Blockers: These drugs can ease anguish among young transgender people and buy time to weigh options. But concerns are growing about their long-term effects.
• ‘Top Surgery’: Small studies suggest that breast removal surgery improves transgender teenagers’ well-being, but data is sparse. Some state leaders oppose such procedures for minors.
• Generational Shift: The number of young people who identify as transgender in the United States has nearly doubled in recent years, according to a new report.
Concerns are, indeed, growing. A regular reader of the Times might conclude that the paper itself is cultivating those concerns—even when the “data is sparse.” With the story about social transitioning in schools, in the past eight months the Times has now published more than 15,000 words’ worth of front-page stories asking whether care and support for young trans people might be going too far or too fast.
That cumulative figure of 15,000 words doesn’t include the 11,000 or so words the New York Times Magazine devoted to a laboriously evenhanded story about disagreements over the standards of care for trans youth; or the 3,000 words of the front-page story from its designated anti-wokeness-beat reporter, Michael Powell, on whether trans women athletes are unfairly ruining the competition for other women; or the 1,200 words of the front-page story by Powell on how trans interests are banning the word “woman” from abortion-rights discourse; or the various expressions of polite skepticism or open hostility toward trans interests from opinion-page columnists like Michelle Goldberg (fretting about “progressive taboos around discussing some of the thornier issues involved in treating young people with gender dysphoria”) or Pamela Paul (citing Powell to argue that trans-rights supporters “deny women their humanity, reducing them to a mix of body parts and gender stereotypes”).
The count also doesn’t include the 2,000 or so words in the story from the roundup box about intimidation and violence against trans people. The Times published that one on page A25.
Page A1 is where questions go. Is the number of young trans people suddenly unusually large? Is it good for young trans people to be getting medical treatment as drastic as breast-removal surgery? If they’re deferring more drastic medical treatment by taking puberty blockers, is it harmful for them to take those puberty blockers? If they’re not getting medical treatment at all, are their schools letting them socially transition too easily?
This is pretty obviously—and yet not obviously enough—a plain old-fashioned newspaper crusade. Month after month, story after story, the Times is pouring its attention and resources into the message that there is something seriously concerning about the way young people who identify as trans are receiving care. Like the premise that the Clintons had to have been guilty of something serious, or that Saddam Hussein must have had a weapons program worth invading Iraq over, the notion that trans youth present a looming problem is demonstrated to the reader by the sheer volume of coverage. If it’s not a problem, why else would it be in the paper?
As with Iraq, the Times is not alone in this. The Atlantic got in early on the topic with a 2018 cover story featuring the headline “Your Child Says She’s Trans. She Wants Hormones and Surgery. She’s 13″—accompanied by a photograph of a model who was 22 years old and who used he/him pronouns at the time. In a now-legendary case study of editorial judgment, the Atlantic also tucked away, in a small headline in the corner of that same cover, “We’re Not Prepared for the Next Pandemic,” by Ed Yong.
The Atlantic story established the template for mainstream coverage of trans matters: an imposingly long account of how challenging and confusing it can be to deal with gender identity nowadays, focused on parents who worry that their child—swept up in a new climate of support and enthusiasm for transgender care—may do something irrevocable to their developing body and regret it later. The writer, Jesse Singal, noted that the “current era of gender-identity awareness has undoubtedly made life easier for many young people who feel constricted by the sometimes-oppressive nature of gender expectations,” but warned of “fraught new challenges to many parents” on “the question of physical interventions.” It was hard, Singal wrote, to get “solid numbers” on how many young people were getting those interventions, but anecdotally, the count “appears to be growing.”
Singal’s story also established the template for the meta-coverage of the subject. Trans writers and activists expressed dismay and outrage about the piece’s alarmist angle; the Atlantic defended it; some of the protests became vituperative and personal; Singal himself curdled over time into, at minimum, a position of combative and obsessive anti-anti-transphobia. The fuss over such an ostensibly thorough and ostensibly reasonable article struck some people with no particular investment in trans issues as censorious and irrational, and those people became invested instead in trans coverage as an object of “cancel culture” discourse: a line of inquiry under attack by the opponents of free inquiry.
The idea that arguments against trans care are forbidden knowledge, which journalists have a duty to bring to light, is still driving coverage. Last week, the Atlantic published a piece by two scholars who are themselves trans, arguing that there is prejudice against people who have transitioned to another gender and then transitioned back, and that discussion of those experiences is being suppressed. “Haven’t seen it discussed much,” the tactically annoying liberal pundit Matthew Yglesias tweeted, praising the piece. “I think since the authors are harder to dismiss than most.”
They weren’t quite so hard to dismiss once you read past their announced identities and introductory expressions of commitment to trans rights and into the substance of the piece, such as it was. The Atlantic writers assured their audience that they were breaking the silence around an important issue. “[T]rans-rights advocates and mainstream-media outlets should stop downplaying the reality of detransition,” they wrote (in a mainstream media outlet), “lest readers and viewers conclude that it’s a negligible issue. It’s not.”
They continued:
For years, the detransition rate was thought to be in the low single digits. In a landmark study of people in Sweden who changed their legal sex from 1960 to 2010,2 percent applied to return to their sex assigned at birth. Other studies suggestan even lower detransition rate. But data are relatively scarce, and anyway the cultural context for trans people has since evolved so much and so quickly that older studies may not adequately predict outcomes for today’s far larger, more diverse trans and gender-questioning population.
The issue is not negligible, yet the available numbers are small, and “data are relatively scarce.” (See also: Singal’s lack of “solid numbers” on youth gender treatment, and the Times‘ “data is sparse” on breast-removal surgery.) Nevertheless—”anyway”!—it was time to discuss the situation, or what they guessed the situation might be.
The inquiries go on, whether there are answers to the questions or not. Last month, as part of an investigative series called “Youth in Transition,” Reuters published a triple-bylined long piece about detransitioning, calling it an “untouchable subject” and a “taboo”: “Understanding the reasons some transgender people quit treatment is key to improving it, especially for the rising number of minors seeking to medically transition, experts say,” the subheadline declared.
In the article, the reporters wrote that “Reuters spoke to 17 people who began medical transition as minors and said they now regretted some or all of their transition.” Before that, the piece quoted Kinnan MacKinnon, one of the trans authors of the Atlantic piece on detransitioners:
In the past year, MacKinnon and his team of researchers have talked to 40 detransitioners in the United States, Canada and Europe, many of them having first received gender-affirming medical treatment in their 20s or younger.
How many minors were they talking to, or talking about, to open this investigative report about trans youth? The sentence started with 40 people, qualified that number down to “many of them,” then described that remainder as being not necessarily minors, but “in their 20s or younger.” And this shrinking and blurry count was the starting point for the analysis.
But here I am, following the reporters and their editors into the weeds, chasing after those elusive numbers. Let’s grant that detransitioners and their regrets are real and countable. Two questions follow, as they do for all the other stories heaped on the pile: So what? And who cares?
Detransition, among the people who get medical gender-reassignment treatment, among the people who identify as transgender, is a tiny share of a tiny share of a tiny share of people. One reason the trans-beat stories offer to justify their own coverage is that various counts about trans kids, to whatever extent anyone has those counts, appear to be rapidly increasing. But that is above all a fact about small numbers (one that journalists persistently misunderstand, across a range of subject areas)—they inherently change at a more dramatic-looking rates than large numbers do.
If there are three genderfluid kids in this year’s senior class of 300 kids, and last year there was only one, the number of kids outside the gender binary has gone up 200 percent! The number of non-genderfluid kids, meanwhile, has declined by 0.7 percent. Are we in a time of urgent and dramatic change, or are we not?
Stories about the sudden rise of trans identity acknowledge the problem of scale, sometimes, in passing. Writing about top surgery for teens, the Times noted that there are other, more prevalent gender-affirmation surgeries going on in the world, too. After scraping together what single-year figures on teen breast removals were available (203 total surgeries across 11 clinics that answered a reporter’s questions, 13 more by one publicity-seeking doctor, 70 at Kaiser Permanente Oakland in a study in a different year), the Times added some context:
Experts said that adolescent top surgeries were less frequent than cosmetic breast procedures performed on teenagers who were not transgender. Around 3,200 girls age 18 to 19 received cosmetic breast implants in 2020, according to surveys of members of the American Society of Plastic Surgeons, and another 4,700 teenagers age 13 to 19 had breast reductions. (Surveysfrom other groups have shown that girls under 18 also receive implants, though the ASPS does not recommend breast augmentation for minors.)
Once you start asking questions about things like breast-enhancement surgeries in comparison to trans care, it’s hard to stop. Some 30,000 teens each year get rhinoplasties—irrevocable, highly visible, life-changing surgeries that are overwhelmingly performed on girls, many of whom are motivated by body dysphoria, peer pressure, and invidious internalized notions about race and ethnicity.
The Times expended more than 6,000 words on puberty blockers, raising the specter that, despite doctors’ widespread agreement that the treatment makes life better for adolescents who identify as trans, the drugs carry the risk of reducing bone density. Bone density loss is also one of the many side effects of isotretinoin, more famous as Accutane, which has been used to alleviate severe acne in millions of teenagers over the decades, even though it comes with a list of potential psychological and physical harms up to and including its ability to cause severe birth defects.
Any medical decision involves some sort of judgment about how to balance competing sets of risks. Yet the Times isn’t publishing multiple front-page stories about whether teens are endangering their bodies by getting treated for cystic acne. The Times‘ gender-treatment coverage insists, through its sheer bulk and repetition, that there is something particularly wrong about the way young people who identify as trans are receiving care. The difficult and complicated decisions that these patients are making in consultation with their doctors are being made wrongly, if not wrongfully. If the Times didn’t believe this, as an institution, the coverage would make no sense.
Maybe the most straightforward point of comparison for the Times reader is abortion. Abortion is, it’s safe to say, an active subject of public controversy, even more so than trans care. It is a medical procedure that makes a permanent change to the patient’s life trajectory, and millions of people sincerely see it as a profound violation of the rules of nature and physiology.
As state legislatures impose new restrictions on abortion, there are no front-page stories in the New York Times about doctors who break from the reproductive-health consensus and raise concerns about abortion’s potential side effects. It is absolutely unimaginable that the Times would publish a pregnant teenager’s psychological history on page one, if the teen wanted an abortion and their parents didn’t trust their child’s judgment. Michelle Goldberg would never insert a caveat in a column about a clinic attack to suggest that the anti-abortion movement raises valid concerns, the way she paused in condemning the Club Q killings to mention the “legitimate debates over questions like when puberty blockers should be prescribed or gender-confirming surgeries performed on minors.”
In absolute numbers, there are many, many more people who regret having gotten abortions than who regret a gender transition. But like detransitioners, they are a tiny fraction of the relevant total. Presented with a study showing that the percentage of patients who regret getting abortions appears to be in the low single digits, Reuters did not send its investigative team to find the exceptions, but simply went with the headline “Overwhelming majority of U.S. women don’t regret abortion: study.”
What makes trans care different? The ordinary liberal reader may be squeamish about this or that aspect of abortion, but they are fundamentally committed to the idea that abortion patients and their doctors are the ones best equipped to figure out what to do with a pregnancy. It is not the job of some outside party or institution—a controlling parent or spouse, a church, a Republican legislative majority, a major national newspaper—to step in and second-guess what they do with their bodies.
For trans care, this liberal theory of autonomy and decision-making is cast aside. The theoretical Times reader is ready to consume 15,000 words about the risks, controversies, and downsides of contemporary gender treatment because, at bottom, they are assumed to be dismayed by it all. An abortion patient is really pregnant, but trans youth—children who “say they’re transgender,” as the Atlantic put it back in 2018—maybe aren’t really trans, or wouldn’t be, if they had more time and better information.
The finer points of this belief are usually laid out only in bits and pieces. Jesse Singal, in a newsletter post defending the Times story about the perils of undisclosed social transition at school, was more direct than the Times itself dared to be:
A lot of kids appear to suddenly (or seemingly suddenly) come out as trans, and anecdotally, at least, it seems like it happens more often in the case of kids who are on the autism spectrum and/or have other mental health problems and/or are dealing with some sort of jarring event, whether a pandemic or a divorce or something else.
That is, the gender dysphoria that leads young people to seek gender treatment is only a side phenomenon of the fact that they are emotionally disturbed, and possibly mentally disabled. In their vulnerability, they’ve been caught up in a wave of sudden public approval for gender nonconformity and pushed to identify themselves as trans. Singal wrote:
…you’ll see that mere discomfort with the way you are “supposed” to act or dress as a boy or girl, and a desire to act or dress differently, means you’re trans (if you want to be), even if you don’t have gender dysphoria. Sure enough, a lot of people, particularly young ones, seem to come out as trans much more to make a statement about their desire to transgress gender boundaries than because they are suffering serious anguish at having a (fe)male body or being seen by others as (fe)male.
The recent increase in the number of young people identifying as trans, by this account, is not mainly because some of the brutal societal barriers against being visibly trans have been lifted, but because fashion and social contagion are capturing more and more adolescent tomboy girls or homosexual boys, lumping them in with the smaller population of genuine trans kids who truly need transition to treat their dysphoria. And then, the story goes, a combination of overeager clinicians and bullying activists—hostile to the very idea of skepticism or doubt—works to steer the not-really-trans kids onto the path toward hormones and surgery, away from their natural bodies and true identities, as fast as possible.
Is it possible that some of these things are happening to some kids, in some cases, to some extent? Singal quoted the World Professional Association of Transgender Healthcare’s Standards of Care, which tell clinicians to consider special assessments for “youth with more complex presentations, co-occurring autism spectrum characteristics, and/or an absence of experienced childhood gender incongruence” and warn that “[f]or a select subgroup of young people, susceptibility to social influence impacting gender may be an important differential to consider.”
Those standards of care are subject to much internal debate, as the Times Magazine covered in its 11,000 words. But if the clinicians who administer trans health care are already weighing these possibilities, why do the readers of the Times or Jesse Singal’s newsletter need to keep worrying about them? Especially when the subject is social transitioning at school, rather than actual medical care? Singal argued that social transitioning is a significant intervention in itself, with serious psychological impacts, and that schools aren’t qualified to make such weighty assessment “on the sole basis of a single child’s say-so.” The justification loops back on its own defining premise: trans care requires extra concern because trans care requires extra concern.
If you don’t grant that distinction, the Times‘ concern about kids changing their social gender at school begins to sound both menacing and absurd, in a recognizable way. It’s the old argument against recognizing gay identity, barely modified from two or three decades ago:
Some parents didn’t think their teenagers were really transgender. Others thought it was too soon to know for certain…
“It’s just been such a hard thing to navigate, because on the one hand, I’m dealing with my very extreme liberal values of individuality, freedom, expression, sexuality, wanting to support all of this stuff,” said a tearful mother. “At the same time, I’m afraid of medicalization. I’m afraid of long term health. I’m afraid of the fact that my child might change their mind.”
What if it’s just a phase? What if they don’t understand the consequences? Singal made a point of rejecting the comparison between kids coming out as gay and kids coming out as trans:
Gender identity and sexual orientation are very different things, and they require different approaches. If coming out as gay required name and pronoun changes, and sometimes was the first step on a short path to permanent medical procedures for which the available evidence is lacking, and if experts believed that it was harder to reliably “diagnose” kids as gay if they had autism or other mental health problems or recent trauma or disruptions to their life… well, in this hypothetical universe, yes, you absolutely would need to loop parents into the process of a kid coming out as gay, at least as a general rule. But in the universe we actually inhabit, if a kid is gay, or thinks he’s gay, you don’t have to do anything. There’s no psychosocial intervention, so there’s no justification for notifying parents.
Jesse Singal was born in the ’80s, so it’s possible he was too young to absorb the abundant ’80s and ’90s rhetoric about the long-term physical and emotional damage young people would inflict on themselves if they started living their lives as gay people. (Anyone who opened the mail at an alt-weekly back then, as I did at City Paper in Baltimore, could expect sooner or later to find a multi-page screed from someone furiously describing the details of anal prolapse.) The idea that coming out as gay is a low-stakes decision is an artifact of the writer living at a very particular moment in history, in a very particular sociocultural space. Plenty of gay kids are still in the closet in 2023!
And Singal, trying to argue against social gender transitioning, accidentally described the logic that keeps those kids there:
[I]f a decision to socially transition that is kept from parents sticks, a young, developing person will then spend months, or maybe even years, living one identity at school and another among their family. That just can’t be psychologically healthy. It fosters distrust between students and parents, and it isn’t sustainable because the parents are inevitably going to find out (if schools think they can keep it a secret in the long term, that’s ridiculous).
If it wanted to, there’s no question that the Times could find parents and support groups who are still bothered, today, by their children identifying as gay. The parents would be furious if the children were out at school without their knowledge, and would feel that their parental rights were being violated. Selected experts would share the parents’ concerns. What would that do for the kids?
And what will all this trans coverage accomplish? The Times considers itself an objective repository of current events, not a crusading newspaper, but when a publication fixes its attention on a subject and keeps it there, it is making the case that its attention matters. If youth trans care is a problem, the Times is bringing that problem to light, so that the public and people in authority can understand it and make it better.
Are kids who identify as trans better off than they were eight months ago? Is the climate of discussion and action around gender therapy healthier than it was before? In what practical direction are these all these thousands of words pointing?
While raising the alarm about children socially transitioning behind their parents’ backs, the Times laid out the political geography of where parental notification is the top priority:
At schools in states such as Michigan and New York, parents said that teachers had used a student’s new name in class but the old one with them, so that they wouldn’t be aware of the change.
But other states, such as Florida, Alabama and Virginia, have passed sweeping laws or issued guidance that prohibit schools from withholding information about gender identity from parents.
If Florida, Alabama, and Virginia are ahead of Michigan and New York in requiring parental involvement in social transitioning, that doesn’t suggest that the push toward requiring notification is moving in the direction of the kids’ greater well-being. In some hypothetical universe, to borrow a term from Singal, opening up the discussion between young people and gender care providers to widespread public review might lead to better understanding and more nuanced treatment. In this world, it seems to have created the space for Ron DeSantis to step in and demand a list of student vaginoplasties.
To the people who’ve decided the press coverage of youth gender care is principally a free-speech battlefront, this is a dangerous, illiberal line of argument. New York magazine’s Jonathan Chait, a tireless defender of center-liberalism against any misbehavior from its left flank, wrote that criticism of trans coverage demonstrates the left’s readiness to “denigrate the very idea of asking questions at all.”
Chait then laid out his version of the left’s version of things:
Any admission of doubt or disagreement within the medical community would give ammunition to Republican politicians to attack all forms of treatment for gender dysphoria.
The impulse to close ranks and suppress all internal doubts—an impulse that dominates conservative-movement politics, and which supporters of the progressive movement wish to emulate—disables any mechanism for correcting errors.
In the spirit of asking critical questions, then: how many thousand words on the front page of the Times does it take to acknowledge the existence of doubt? At what cumulative word count does it become possible to read it as something less neutral—something that could in fact give ammunition to Republican politicians?
What if, perhaps, a mainstream liberal moral panic about young trans people has been moving in synchrony with “a barrage of bills to regulate the lives of transgender youths, restricting the sports teams they can play on, bathrooms they can use and medical care they can receive”? What if the laws are being promoted by “some of the same figures who fought the legalization of gay marriage”?
And what if the latest wave of this legislative assault included “bans on transition care into young adulthood; restrictions on drag shows using definitions that could broadly encompass performances by transgender people; measures that would prevent teachers in many cases from using names or pronouns matching students’ gender identities; and requirements that schools out transgender students to their parents”?
This was what the Times reported on Jan. 26, three days after it had used its front page to air parents’ objections to teachers using names or pronouns matching students’ gender identities, and letting those parents suggest schools should have requirements that out transgender students to their parents.
In this story about new legislation, the Times raised the possibility that the interest in young people’s welfare was a tactical pretext by the far right, the opening stage in a full-on campaign against trans people:
Matt Sharp, senior counsel and state government relations national director for the Alliance Defending Freedom, said his group believed “gender ideology attacks the truth that every person is either male or female.”
And Mr. Schilling, of the American Principles Project, confirmed that his organization’s long-term goal was to eliminate transition care. The initial focus on children, he said, was a matter of “going where the consensus is.”
This news ran under the headline “G.O.P. State Lawmakers Push a Growing Wave of Anti-Transgender Bills.”
It was on page A13.
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