On June 15, 2022, the New York Times Magazine published a piece by Emily Bazelon about healthcare for transgender and gender diverse youth. It was assigned by editor Jake Silverstein and centered on the 2022 Version 8 of the WPATH Standards of Care, a ritual document developed in the 1950s and codified in 1979 to protect healthcare providers from litigation and legislation via medical gatekeeping.
About a month after the 2022 trans piece ran, Bazelon deleted all Twitter posts. Below are the relevant deleted tweets. Each bullet is a separate tweet, in order posted by Bazelon.
@emilybazelon June 15, 2022:
- For @NYTMag, I wrote about transgender healthcare for teenagers and the debate among medical professionals who treat them. [link to NYT article]
- Here’s a gift article from NYT, meaning anyone can read it through this link (I hope!). [link to NYT article]
- The focus of the story is a chapter on adolescents in a set of guidelines known as the Standards of Care, to be released by the World Professional Association for Transgender Health (@wpath) this summer. It’s WPATH’s first update of the Standards in a decade.
- WPATH’s Standards of Care are meant to set a gold standard for the field of transgender health. A draft was released in December. The adolescent chapter is one of 18 chapters—and the one that generated the most discussion and debate.
- WPATH gave me exclusive access to the final version of the Standards of Care & lifted confidentiality agreements so I could talk about the process of creating it with some authors, who are clinicians & researchers (trans, non-binary, cis) with long track records in the field.
- I also talked to many young people and parents for this story. Their voices stayed with me. Thank you all for talking to me. I learned a ton from you. I’ve tried to represent many points of view in my piece.
- As is often the case in medicine, the crux of the story is about how to apply existing research for the growing numbers of patients — in this case, teenagers — lining up for care.
- The intrusion of politics into science makes it more difficult to set standards and to provide care. It is really hard to work on *improving* the quality of care when politicians are trying to ban it.
- But that’s what’s happening as some states pass or consider bills to outlaw gender-affirming medical treatments for minors.
- As with other fraught issues like abortion, America is becoming a split screen. In some states, gender-related care for young people is already rare yet faces legal threats.
- At clinics that are mostly in progressive metropolitan areas, meanwhile, it’s not clear how common comprehensive assessments are. This is the type of evaluation, before medical intervention, that the new Standards of Care recommends.
- Some families are bewildered by a landscape in which there are no labels for distinguishing one type of therapeutic care from another.
- This is all unfolding as the number of teenagers who identify as trans in the U.S. is significantly rising, as my colleague @azeen reported last week. (Azeen is the fabulous NYT reporter on this science beat and if you’re interested in this issue, you should follow her!)
- There are a lot of links in the piece to scientific research. Here also are a few historical sources that I want to highlight, starting with this article on the origins of WPATH by @beansvelocci [link to Standards of Care: Uncertainty and Risk in Harry Benjamin’s Transsexual Classifications]
- The book Transgender History by @susanstryker [link]
- The book Histories of the Transgender Child by @gp_jls [link]
- This 1987 essay by Sandy Stone [link]
- This 2018 essay by @andrealongchu [link to On Liking Women]
- Comments are open on my piece and I’ll try to respond to some later today, at the NYT link above.
- I think an important point has gotten lost in the Twitter din over my @NYTmag piece on gender therapy for teenagers. (For the record, the response has been far different in NYT comments and very positive feedback from readers, including trans people & practitioners in the field.)
- I have zero appetite for Twitter combat. It’s been horrifying to me to be called a murderer and compared to Nazis for writing about a debate that is happening, with consequential effects, *within* the field of gender-affirming providers.
- I’m responding in this thread to criticism, not really expecting to persuade anyone to change perspectives, but to make some basic points about journalism that apply in this case and others, I think.
- 1) Criticism: The timing of the story was wrong because of the right-wing assault on trans rights. –My editors and I talked a lot about the political backdrop, which is threaded through my story and has deepened divisions in this field.
- We decided the conflict makes WPATH’s Standards of Care, issued for the 1st time in a decade, more important. The Standards are the story’s focus *and the source* of the points that have caused controversy here, about how teens should be evaluated & the role of social influence.
- The Standards at issue in my piece have the consensus support of the working group that wrote them and of WPATH’s leadership. Those groups include trans and non-binary practitioners.
- 2) Criticism: The framing of the story was wrong because it didn’t center the trans community. –No group of millions of people has a single community. It’s true that this story didn’t center trans activists or trans kids. (Though I did quote them at length.)
- Those are also good stories, which the NYT has told and will tell. But this one is primarily told through the eyes of clinicians in & around WPATH. It’s about a scientific debate. Trans providers express every point of view the story contains about gender-affirming care.
- 3) Criticism: The story doesn’t include trans kids who are doing well. –False. Two kids in the story, nicknamed Tori & Charlie, are medically transitioning & thriving. Two adults (Yael & F.G.) speak to how critical transitioning in adolescence has been for their well-being.
- 4) Criticism: The story “platformed” the wrong people. –The story, in a total of 11,400 words, includes 363 words from the perspective of parents who are skeptical of medical interventions for minors. Some are affiliated with the group Genspect.
- I made it clear what Genspect stands for by including comments of members & a post on strategy from an affiliated Substack. Skeptical parents are politically active, testifying in statehouses in favor of banning medical interventions for minors. Leaving them out of the story … would deny that reality, which would be a disservice to readers who want to understand the full landscape.
- 5) Criticism: There’s no evidence that substantial numbers of kids are transitioning without the kind of diagnostic assessments or process WPATH recommends. –No one is tracking this. Anecdotally, many clinicians—not one or two & very much including trans clinicians—told me … they are aware of this happening. I heard firsthand accounts—from teenagers as well as parents—of clinics offering medication during a first brief session. I did NOT hear of this in states that are proposing bans, where care seemed to be more conservative.
- Parents can say no to medication. But doing so when a provider is offering it can cause serious conflict within families. I’m surprised to see journalists who have not covered this topic dismissing the assessment issue out of hand when it is a focus of WPATH’s Standards of Care.
- 6) Criticism: Patient Zero is an offensive term –I referred to F.G., the first Dutch patient to take puberty suppressants as a teenager, as Patient Zero because the Dutch used that term for him & he used it in our interview.
- Readers have pointed out the term is associated w/ communicable disease. Because of how the Dutch use it, I didn’t think of that association. Neither did anyone who read the piece before it published, including our outside trans readers.
- In the context of my story, Patient Zero means the first adolescent to receive gender-affirming medical treatment.
- tl;dr: Much of the criticism of my piece reflects a profound disagreement over the role of journalism on a controversial topic involving a vulnerable group.
- To me, being a journalist means following the facts where they lead. It isn’t advocacy. I didn’t know where this story would go when I started reporting eight months ago.
Bazelon, Emily (June 15, 2022). The Battle Over Gender Therapy. The New York Times. https://www.nytimes.com/2022/06/15/magazine/gender-therapy.html