Don’t forget bodily autonomy: a plea from a trans critic of COVID policy

This is a new (more specifically COVID-response-critical) version of my previous post in March. That post argued that it was the style and means of transgender revolution causing the current backlash; this one argues for some ethical and logical consistency in how folks who (in my view rightfully) argue for bodily autonomy in the face of COVID should be consistent in the super-heated discussion of transition medicine, particularly for minors.

A lonely island

In March 2020, I watched, appalled, as governments around the world declared that they would be shutting down businesses, schools, and even private social gatherings to stem the spread of SARS-CoV2. We were being blasted with simplistic, moralizing slogans about “two weeks to stop the spread.” These messages went against the compassion and transparency that public health experts had advocated for years, against existing understandings of highly transmissible respiratory viruses—and against any rudimentary understanding of our complicated, intertwined global economy. 

Perhaps even more fundamentally, as a queer and transgender person, I am a strong supporter of the right to bodily autonomy. Curtailing such freedoms for many millions was a massive step, and I did not find the empirical evidence in defense of lockdowns and other mandates remotely sufficient, on an ethical level, to justify the policies.  

Though I initially felt very alone in these thoughts, I found many allies over the following months and years from across the globe and the political spectrum. I commiserated with devoted Catholics, professed libertarians, Trump voters, Bernie loyalists, Brexiteers, restaurant workers, bar owners, overburdened nurses, and Silicon Valley tech bros. Especially relieving was realizing that there were other longtime Democratic voters who were horrified and enraged by the way that COVID interventions were turned into political theater. 

Together, we raged against the hypocrisies and myopia of the corporate-controlled, bureaucratic, technocratic powerholders who kept trying to dehumanize our fellow citizens, hypocritically belittled bodily autonomy and other fundamental freedoms, and cudgeled us into compliance with black-and-white stories of good versus evil. We called out the smug, narrow perspective of those easily able to work from home. These perspectives were particularly painful to witness because I became a tenured university professor in 2020 and, on paper at least, am now solidly a member of the Professional Managerial Class.

Even more agonizing were the reactions among the LGBT communities with which I had been involved. In-person support vaporized. Gender-affirming surgeries were canceled. Pride events, upon which many queer-owned independent businesses depend, were cancelled for two years. The harms of “stay the f*ck home” for queer and trans people forced into unsupportive or even abusive living situations were quickly glossed over, or, worse, attributed to COVID-19 itself. My spouse—who is also transgender—and I learned to tread carefully in online trans and queer spaces lest we face social exclusion for voicing the most modest of criticisms about the moral panic over “the unvaxxed” and “anti-maskers.” 

With the dropping of COVID mandates in recent weeks, my partner and I looked forward to reconnecting, slowly, with the world. Then J.K. Rowling’s tweets alleging that allowing easy gender marker changes on documentation would lead to women’s sexual victimization started making the rounds again. What disturbed me even more than Ms. Rowling’s caustic, unreflective words was the fact that quite a few left-leaning critics of pandemic excess whom I had come to respect seemed to agree with her. In particular, commentators focused on the hottest button of all: transgender minors.

“I never could understand why the LGB community allowed Trans to co-opt their movement. Many more rights/laws could be enshrined by now if they didn’t all include gender identity (something most don’t agree with & targets kids),” wrote one on Twitter.  

“I think we’d be in better shape as a society if you didn’t even have to humbly fashion a clear & true matter of concern about dangers to children,” wrote another.

These folks—self-avowed left-leaning types—seemed to be completely in agreement with recent legislation in many U.S. states against trans girls and women in sport (Arkansas, Kentucky, Missouri, Tennessee, Utah), medical transition for minors via “puberty blockers” (typically gonadnotropin-releasing hormone, or GnRH, analogues) and hormone therapy (Arizona, Idaho, Texas), changing gender markers on documents without genital surgery (Montana), and limiting other aspects of trans people’s bodily autonomy. And they paid little attention to the diverse viewpoints and backgrounds of actual transgender people.

For two years, I felt like I stood on a tiny island in an increasingly rancorous sea. Now, that island seemed to have eroded even further.

A need for nuance

I understand why many allies in arguing against the authoritarianism of COVID measures are arguing against medical transition access for young people. Many fighting mandates imposed on schoolchildren and youth did so from the angle of parents’ rights: if parents did not want to mask or vaccinate their children, if parents wanted schools to be open normally, then parents had the right to agitate for these measures. To those who agree with this line of reasoning, measures that would compel teachers or school counselors to report a student’s gender questioning to parents may seem beneficial and appropriate.

Another reason for COVID response critics to argue against transgender activists is that COVID critics (rightfully) question the hyper-medicalization of life, in particular the idea that a single intervention (a COVID vaccine or hormonal therapy) can be almost magical in its transformative properties. There is no “one weird trick”—be it lockdowns, vaccines, and masking, or hormones, surgery, and GnRH analogues—that can instantly resolve a complex, painful situation. 

Finally, many protesting the excesses of COVID mandates are critiquing an entire system of anti-democratic credentialism, elitism, and corporate greed. Over the last two years, we’ve seen heads of state speak of significant proportions of their citizenry essentially as criminals and invoke emergency laws in unprecedented ways (like Justin Trudeau of Canada). We’ve watched powerful media outlets being univocal in their portrayal of a complicated, evolving global situation clearly not easily repaired by any “quick fix.” We’ve heard the most prestigious experts endorse self-contradictory, unscientific measures (by calling those who argue for reopening public schools without restrictions “white supremacists,” for example, when it is disproportionately poor, racialized students who have suffered from such closures). We’ve witnessed organizations and individuals once proudly standing for democratic principles and open exchange of ideas clamp down on discourse classed as “misinformation,” even though we know curtailing freedom of expression can be dangerously counterproductive. We’ve seen pharmaceutical profits boom as governments stock up on COVID tests and vaccines—and as those with significant conflicts of interest (like Dr. Scott Gottlieb, former FDA chief and Pfizer Board of Directors member) nonetheless receive massive amounts of media attention. Anger and incredulity among a wide swathe of those forced to live under such conditions is completely understandable.

In the eyes of those rallying against this convergence of state, corporate, bureaucratic, and technocratic power, transgender rights proponents have acted in similar ways: invoking the pronouncements of experts as uncontestable evidence, uncritically buying into corporatized biomedicine, and chilling debate about transition and its consequences with accusations of “transphobia,” a term rich with implications of moral degeneracy and intellectual backwardness.

But, even as I can see why those critical of COVID extremism might be critical of access to social and medical transition, there are important considerations that I hope my allies of the past two years will take into account before they click “like” on a J.K. Rowling tweet or share an image like this cartoon by Bob Moran.

Why critics of COVID responses need to be critical of anti-trans legislation

Don’t disguise feelings as Science™:

First, fellow critics of the COVID response have repeatedly pointed out how many measures have been more about beliefs and emotions than about empiricism or science: rules that forced customers to “mask up” for a few feet between the door of a bar and their seat, for instance, or the assumption that schoolchildren are vulnerable in spite of robust evidence that their risks, even without a vaccine, are up to hundreds of times less than for their vaccinated elders. This same mindset should apply to discussing transgender adults and youth. “I am afraid of this, so it must be wrong and bad” is not really a scientific or rational way to think, much less a way to make sweeping policies.

I understand why some think being too glad-handed with medical interventions for minors is troubling. But current gold-standard care guidelines are actually very cautious about medical intervention for youth. The WPATH (World Professional Association for Transgender Health) guidelines do not recommend hormone therapy for those under 16, nor genital surgery for those under 18, for example. If the concern is with “irreversible” biomedical interventions, then surely it would be fine for children and teenagers to experiment with gender presentations and to socially transition? Surely it would be fine to enact legal and social protections for trans youth and adults who do not medically transition or who are non-binary—for example, by introducing an “X” gender marker for documents?

But if non-binary appearances and gender markers or social transition still feel “wrong” (as suggested by the Bob Moran cartoon above), then the issue is not really with the empirical costs and benefits of medical transition. It’s a gut feeling that there must be something wrong about transcending the normative expectations for gender at all. And this feeling is essentially the same as the (mistaken) feeling that schoolkids “must” be COVID superspreaders, or that cloth and surgical face masks “must” improve global COVID outcomes. If revulsion and fear are at the core of one’s attitudes toward trans people, then no arguments based on data can really change one’s mind.

Data is imperfect, as any critic of COVID research knows. We have asked questions like: how many people were hospitalized “with” COVID-19 (incidentally testing positive), and how many were hospitalized “for” COVID-19? Have mortality counts been inflated? How many people have been infected and recovered without even being tested? How have confounders distorted assessments of vaccine and booster efficacy? Similarly, those arguing for transition access should be franker about data imperfections. Indeed, there is a lack of high-quality evidence about the potential long-term effects of GnRH analogues when used in trans youth, and a lack of high-quality evidence about much of trans healthcare in general. But, the data we do have indicate that the vast majority of people who undergo surgery as part of their transition are happy about their decision, and that testosterone levels do not necessarily correlate with muscularity or exceptional athleticism unless at artificial levels, for example. Where data is less complete, the best approach is to perform larger, higher-quality trials. In the end, neither lauding “puberty blockers” as magical nor condemning them as poisonous is scientific—or humane.

Parental rights

Second, parents and guardians who have argued fiercely for the right to have their children attend school, sports, or other activities without covering their faces and being mandated to receive COVID vaccines but who argue similarly fiercely against minors’ access to transition seem to forget that minors already require parental permission to undertake medical transition. WPATH explicitly advocates for a close consultation among trans youths, their caretakers, and their healthcare providers when it comes to “puberty blockers,” much less hormonal therapies or surgeries. Trying to make parents and guardians who support their minor children’s medical transitions criminals, like politicians in Idaho or Texas are trying to do, is in the same spirit as threatening to take children from parents who do not want to give them a COVID-19 vaccine or force them to wear a mask at school. If you call one example abuse, recognize that plenty of others call the other abuse too. 

“Regret” and individual choices

Third, I have seen many critics of COVID extremism talk about the potential for people, especially youth, to “regret” their decisions to seek medical transition, and much emphasis on the “irreversibility” of medical transitional steps. Author Abigail Shrier, for example, has called youth who question their classification as girls the victims of a “transgender craze” that, per the title of her 2020 book, causes “irreversible damage.”

But a major ethical and emotional reason that many of us rejected the excesses of COVID policies and mandates was that we don’t believe sweeping rules backed by the force of the state should be imposed on all of us in order to guard against the possibility, no matter how small, that someone might be harmed. Many of us denounced the idea that a risk-free life was possible or worth living. We rightfully argued that people should be free to make bodily decisions for themselves, even if it meant they might later regret those decisions. With good reason, we have rebutted arguments that emergency powers and mandates should become a part of public health’s repertoire because a “new threat” could at any time appear.

Critics of COVID policies also correctly identified the problem of media outlets using emotional anecdotes about outlier cases, such as a child or young adult who perished from COVID-19, to convince audiences of the need for extraordinary measures. If we criticize such fearmongering about an endemic respiratory virus, then we should also be critical of using similarly emotional tactics about the medical decisions of transgender people. 

If, as some posit, increasing numbers of young adults and teenagers identify as transgender and seek out social and medical transition, then is that desire not something the rest of a society should take with good faith? To dismiss the bodily autonomy of another person on the basis of “misinformation” or “propaganda” doesn’t sound very different from dismissing the right of another person to choose whether or not to receive a COVID-19 vaccination because they have consumed too much “fake news.”

What is the imagined outcome if every person who wanted to transition were allowed to do so? If that number is a small percentage of the population, then the level of furor over trans people seems unwarranted. Their bodily autonomy and minority rights should be respected, and their decisions will make them happier, more highly functioning people. If that number is very large, then we should consider whether the existing assumptions and rules we have about sex, reproduction, gender, and bodies are actually doing more harm than good for us as a species. This is not substantively different from arguing against COVID-19 vaccine mandates, which met with significant opposition in many jurisdictions. By disregarding the plurality in opposition, mandate-makers have arguably done more harm than good to the population by pushing many of those at higher odds of serious disease and death away from receiving vaccines, and by weakening socially health-promoting factors like interpersonal trust and connection. Are opponents of transition access sure they are not doing something similar?

Let’s get real

What we are really arguing about when we argue about trans youth, transgender athletes, and whether non-binary people are real are our feelings about the current gender, sex, and reproductive norms and systems. These norms have ancient precedents in patriarchal societies across the globe and more recent roots in the medicalized view of heterosexual reproduction as the most natural (and therefore best) form of gender and sexuality. Yet, they also have many exceptions in natural history and human social history, from clerical celibacy to third-gender people, from sex-swapping species to intersex individuals. Gender and sexual diversity is, like the endemicity of COVID-19, simply a fact of our species.

Yes, some who argue in favor of changing existing assumptions about gender and sex are resorting to harmful, illiberal, myopic tactics. Often, queer and trans activists seem to claim the mantle of ungovernable Stonewall rioters and the complacency of cultural authorities simultaneously. This will work no better than insulated “laptop class” experts telling folks that enjoying social life during a pandemic is “evil” or that reopening public schools is “racist.” Some LGBT discourse veers into streamlining raw human diversity and fluidity in ways that serves corporate profit margins more than actual queer and trans people. Corporate attempts to sell goods, like this advertisement for a menstrual tracking app, end up offending every possible target audience.

But those who “like” and “retweet” JK Rowling and other prominent anti-trans figures make some of the same mistakes. They end up battling caricatures in ways that accrue fame and profit to powerful people while forgetting that there are real, complicated human beings on the “other side” of the debate. Many trans people have complicated feelings about social and medical transition. Debates rage within the community about non-binary presentations and identities, about what masculinity and femininity mean, about whether rainbow-washing and sloganeering have gone too far, and even about whether it’s a good idea to ask people who don’t know one another well to share their pronouns. There is no “gender cult”: simply approach trans people with respect, and you will find all sorts of diverse viewpoints, including on transition-related issues. But most transgender people, just like most who’ve criticized COVID policy excesses, believe firmly in the importance of the freedom to make our own medical choices.

If we’ve learned anything from the COVID years, it’s surely that dragooning others into compliance, cloaking emotional and moral arguments with The Science™, and calling anyone who dares to question the narrative  an immoral villain are practices that further divisiveness and animosity without necessarily even being helpful to our cause. The corporatized, bureaucratized, techno-feudalistic powers that be are eager to prey on our instinctive tribalism. We must resist them. We must talk openly about our values, since values are what ultimately guide how each of us, credentialed or not, interprets empirical evidence. 

In my case, the same commitment to bodily autonomy that is part of my decision to transition carries over to my views on COVID policy. Most importantly, regardless of our feelings about public health policies or about gender and sex, we need to debate via person-to-person, real-life, in-person interactions. We desperately need to find new ways to live together, not new ways to cast people out.

Author: tranquilfire

nonbinary transmasc |they/he| evolving my Pokémon| reader, writer, hiker, lifter, lover(?)

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