How Many Trans People Does The New York Times Believe There Should Be?

I spent my first year taking hormones on high alert for any signs that I might be having a stroke. Before I was able to obtain my too-small prescription doses from a clinic in southeastern Michigan, my doctor there warned me that doing so would put me at a high risk for what had previously been a mostly abstract medical concept to my young self. I was told to be ready to call 911 if I felt numb on one side of my body, to inform my roommates of the possibility so they would know how to help if it became reality, and to never, ever smoke another cigarette if I didn't want to risk my own blood trying to assassinate me.

I don't think this is an inherently wrong thing for a medical professional to do—it's bad to smoke, it's good to know the signs of various health emergencies, and it's fine for them to err on the side of caution with this stuff. But this chat also gave me a woefully skewed idea of transition as sacrifice—that Little Mermaid trope in which the body you want only comes at great personal risk and cost to yourself. I stayed extremely worried about strokes until another trans woman gave me something closer to the full picture: Women in general have a higher risk of stroke than men, and those on certain kinds of birth control—essentially another form of hormone therapy—have an even more elevated risk. The greater stroke threat wasn't some unique punishment for being trans; it was just part of the territory of being a woman in this universe.

I was thinking about this misunderstanding, and my willingness to believe the worst about trans healthcare, when I read yet another lengthy feature about young trans people in The New York Times. The Times publishes a lot of these hysterically pitched concern pieces, likely because their enthralled centrist audience clicks on them regularly and because they happen to employ a lot of writers whose values align with that audience. The headline on this one, by Megan Twohey and Christina Jewett, is "They Paused Puberty, but Is There a Cost?" The formula is familiar to students of the craft: using passive voice to present the cis authors' own opinions under the veneer of objectivity, deploying a rare example of a detransitioner to try and shock readers, and ignoring the overall opinion of the medical establishment in favor of gut feelings from individual doctors.

I'm curious what those who haven't read this story yet think the headline is referring to when it says there is "a Cost" to puberty blockers. Is it the often high price of gender-affirming care in a country where health insurance drags its feet on covering these needs? It's not. Is it social isolation, depression, and thoughts of self-harm? Nope, that's actually what happens to a lot of trans kids without blockers. Oh god, wait, is someone having a stroke? No! The "cost" that the the Times is referring to in this headline has to do with bone density—specifically cases in which the bone mass of trans kids flatlines while they're on blockers in comparison with their growing peers. But the article is not simply about a potential side effect of an increasingly mainstream drug. It uses the limited observational data out there to sharply pivot into an exploration of hypothetical fears about how the blockers might affect these kids when they're older.

While the story does mention one trans girl who takes calcium and exercises and has healthy bones, and says "many doctors treating trans patients believe they will recover that loss when they go off blockers," it becomes saturated with broad, clichéd moral panic about improved access to care:

Most patients who take puberty blockers move on to hormones to transition, as many as 98 percent in British and Dutch studies. While many doctors see that as evidence that the right adolescents are getting the drugs, others worry that some young people are being swept into medical interventions too soon.

New York Times

There's so much wrong with the tone of this piece and so many little things that don't survive scrutiny—I personally hate the oxygen given to the idea that "puberty can help clarify gender," and as such can be a positive experience for stressed-out trans kids who need to confirm that they really do hate their bodies. But the complete unknowns on which Twohey and Jewett's arguments rest actually do hint at a meaningful problem. For generations, trans people have been frustrated by the willful ignorance of the medical establishment, which leaves us feeling around in the dark for anecdotal data about the ways our bodies work instead of relying on solid, peer-reviewed studies we can trust. There's still so much I want to know about myself and my hormones that just hasn't been closely examined by anything more rigorous than a Reddit thread.

More important than my own curiosity is the fact that trans kids deserve detailed care and attention from medical professionals who are always looking for improved ways to aid them. The pending research on bone density certainly falls into that category. As, finally, more resources can be used to track their progress, I'm hopeful that the assistance these kids receive evolves to be more effective as time goes on. But what worries me about the Times, and its willingness to follow its catastrophizing fantasies farther than any evidence can support, is the framing of trans treatment as something like a rare necessary evil instead of a life-saving gift. All of these Times articles seem to work backwards from the same rickety conclusion: that while there are some kids who are better off on this path, all but the most undeniable cases of dysphoria should be forced to gut it out until adulthood.

In the process of running these stories, the supposedly objective paper has inserted itself as a gatekeeper in the fight to help trans kids get what they need. By using the existence of one frustrated woman with "a voice that sounds like a man’s," by forgetting about the many parents who would rather pressure their kid into heteronormativity than allow them to see a gender specialist, by muting the consequences of not acting while turning the volume up on conservative culture shock, the Times and its reporters enable the most disgusting people in this country to justify the criminalization of trans healthcare. Taking the side effects that members of a specific community might experience while making a potentially life-saving medical decision in consultation with their doctors and reframing it as a potential outcome so dire that it deserves a New York Times longform does nothing but put a bigger target on that community. Look at how the loudest opponents of trans freedom are unanimously, vigorously praising Twohey and Jewett's work, all because of some inconclusive observations about bone density:

Every single medical choice we make for ourselves or for our children can be framed by its dangers instead of its benefits. Even though it's important to have a complete picture of what a drug or treatment can do before taking it, widespread fear-mongering over rare and manageable adverse reactions is proving to be more and more of a threat to public health, undermining trust in the safest options we have because some folks have a bad feeling about it. Combining the fragile, still-burgeoning field of adolescent trans medicine with the ugliness people display when their children and the world around them don't line up with how they want them to be creates a potentially awful, deeply frustrating situation for the actual kids who need this care, and might die without it. But again and again, these Times features hand-wave the appalling actions of officials in places like Texas and Florida while framing trans people themselves as the ones whose decisions need to be questioned and most closely scrutinized.

I haven't had a stroke since I started on hormones, even as I've made plenty of less-than-healthy life choices. I had an issue for a bit where I found it very difficult to wake up in the mornings, and felt more tired during the day, but it turned out that the loss of testosterone just made me an iron-deficient girlie—treatable with a drug-store supplement. In the same way that my head felt stormy after getting the COVID-19 vaccine (four times), or my vision got briefly blurry after giving blood samples, I accepted these hurdles as the cost of being human. Our bodies will never be flawless, and the quest to be as mentally and physically healthy as we want is always going to be complex, taking us down unpredictable roads no matter what issue we're dealing with.

Once trans people enter the picture, though, institutions like the Times are eager to reimagine the remaining limitations of modern science and the inherent chance of side effects that come with any medical treatment as invalidating flaws. I want to say I don't know why our little dysphoric selves and our healthcare choices get singled out this way, but you don't have to think too hard about why the Times continues to do this before the logical conclusion becomes clear: The Times believes there's an ideal number of trans people who should be alive in the world, and we're dangerously close to exceeding it.