‘Woke’? Existential? A political football with young lives at its core.
Few issues are as fraught as those around medical intervention and early gender identity. Even the language is strewn with mines. For some politicians, that makes it easy to weaponize. Our reporter set out to supply some context.
How can a writer apply fairness to a debate on an issue that one side views as an urgent need, the other as delusion?
Monitor correspondent Simon Montlake headed to Missouri to take a closer look at efforts there and in other red states to restrict gender transition for minors, which is emerging as a key issue in the 2024 campaign.
“It’s clearly an animating point on the right of American politics,” he says on the Monitor’s “Why We Wrote This” podcast. At least 16 states now ban or restrict medical interventions such as puberty blockers for those under 18.
There is also a debate within the medical community on the long-term impact of such treatments – and what may be contributing to the surge of young people seeking them. Some European countries are revising their protocols to ensure adequate mental health care before opting for medical interventions.
“There is genuine concern and frustration about how quickly transgender issues seem to be pushed into the mainstream,” Simon says. “But a more strategic thought I had is that this is a great issue to campaign on. It unites the conservatives; it also divides the other side.”
But for the families of trans children, navigating this relatively new issue can be a “wrenching decision.” “I found that talking to the parents gave me a very moving insight into the dilemmas they face,” he says, “and also how they feel about their children being made into a political football.”
Episode transcript
Gail Russell Chaddock: Fairness can be an elusive quality in today’s media environment. Editors, fact checkers, readers can help, but in the end, it comes down to a commitment by all to be fair, to listen closely, to think deeply. Today’s podcast takes up a new frontier in American politics: whether minors should have access to gender-transition treatments.
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Chaddock: This is “Why We Wrote This.” I’m this week’s guest host, Gail Chaddock. Simon Montlake is a reporter for The Christian Science Monitor in Boston. As a Monitor correspondent in Jakarta, Bangkok, and Beijing, he covered political upheavals, economic crises, civil wars, and natural disasters. Born in London, he’s now reporting in a former colony, with an eye on national politics. We invite you to listen and think deeply about today’s issue, and help us answer the question: What is fairness?
Simon, thank you for joining us today. Why did you choose this topic?
Simon Montlake: This was a topic that both my editor and I saw as worth pursuing, particularly in light of the 2024 campaign. It’s clearly an animating point on the right of American politics. And what we’re seeing is that how this is playing out, in terms of action, is at the state level, rather than federal. And so I went to Missouri. In Missouri, at the beginning of the legislative session back in January, the leadership of the Republicans made clear that one of their priorities for the session was to legislate on transgender issues.
And one of those is the question of medical intervention for under-18s, which is sometimes called gender affirming care, which is a slightly vague term but really comes down to using medical interventions, along with psychiatric treatment, to “change” or “transition” the gender of the individual. We wanted our readers to understand that there is a debate within the medical community, particularly on the research side, because this is fairly new and it’s hard to be clear about the long-term implications, and to understand whether the increase in young people seeking this care is something to be concerned about. We also wanted to put in context for American readers the fact that this is not the only country where this debate is happening. It’s happening in many countries in Europe. And in some cases they have chosen to restrict somewhat or rather revise the protocols of how they treat young people who have what is called gender dysphoria, in which you feel that you’ve been born in the wrong body.
Chaddock: Who did you write this story for?
Montlake: In some ways it goes back to when I was in Iowa in March, covering former president Donald Trump, who held his first big rally of the electoral cycle there. And he filled a theater with supporters of his, and gave a very long speech. He talked about ethanol, about corn subsidies, about farm policy, things that, I suppose, he believed would be important in Iowa. But the one sentence or statement that really got people onto their feet was talking about what is taught in schools and also stopping transgender athletes competing in schools, and really a broader sense of like, we’ve got to stop this “woke ideology” of transgender. And people were up on their feet. When I looked around at that crowd, I would say most of them were probably grandparents by this point. Almost 100% white. You might say middle- or working-class people. You know, in some ways, I suppose I was writing for those readers who perhaps don’t have a firsthand experience of this issue or exposure, and would also have very different views from how young people see this issue.
Chaddock: How did you choose the voices for this story?
Montlake: Well, it was of course important to talk to lawmakers involved in passing the legislation. We also wanted to hear from families of young people who are either accessing this medical transition care or in some cases, perhaps, are too young for it, but already have identified themselves as being transgender. And then there are, also those who are no longer 18, who would not be affected directly by what eventually happened, which is a ban on under-18s receiving this treatment. But it was really the families I found most compelling. It’s just such a difficult issue, such a hard and wrenching decision to make for someone who wants the best for their child, and is perhaps confronted by this entirely new issue. And so they’re looking for guidance from medical professionals and they’re also talking to other families. And at the same time, I also wanted to speak to parents who felt that there should be restrictions or an outright ban on this treatment. And I did talk to a parent of a transgender child who felt that way.
I didn’t talk to the children themselves. There was always a question in my mind about their privacy and how it would be for them to be put in the limelight like this. But I found that talking to the parents gave me a very, very moving insight into the dilemmas they face and also how they feel about their children being made into a political football, frankly.
Chaddock: You mentioned at the beginning that this is a debate going on not just in the United States, but in a number of countries around the world, including and especially Britain.
Montlake: In terms of the debate in say, the UK, what’s happening there is that the one clinic in London, which was the only place you could get transgender transitional care, they are now moving that service to other hospitals. There have been a lot of complaints and concerns about whether the treatment there was following the right protocols and whether there were sufficient guardrails in place before treatment was prescribed. But the UK, I should note, is not stopping this treatment. And in fact all the countries in Europe where you’re seeing this debate happening, the regulators will say: “We want to just increase the screening and make sure that only in exceptional cases do we proceed with medical care, while we also consider psychiatric care, the social situation, and many other things.” And again, there’s this idea or fear that perhaps there is some sort of peer or social pressure, which is leading more adolescents to believe that they want this treatment. But in no countries are we seeing the politics of the United States, in which you have one political party, well organized, with national groups working in all these states, and in many cases passing almost identical laws, which don’t just intervene and try to regulate more tightly, but outright prohibit the practice.
Chaddock: What’s behind this rush to legislate in red states?
Montlake: It’s clearly a political strategy on the right. You don’t have to go back far to see a parallel. I mean, 20 years ago, the issue was same sex marriage, and on the right it was defense of “ traditional values and traditional marriage.” And in fact, in the 2004 election, president George W. Bush made this one of his promises, that same sex marriage could not go ahead. In that case, of course, the culture moved on, politics moved on, and same sex marriage is now the law of the land. Some of the same political groups, often conservative and Christian legal groups who were involved in the litigation over that issue, are now heavily involved with the transgender issue, both the medical care, and also the so-called bathroom bills, sports, and other areas for transgender people.
And I think, um, there is genuine concern and frustration about how quickly transgender issues seem to be pushed into the mainstream, but a more strategic thought I had is that this is a great issue to campaign on. It unites the conservatives, it also divides the other side. Within progressive or Democratic, or independent voter circles, there is no unanimity behind supporting transgender communities or transgender people or transgender rights. So it is an issue that splits the opposition. And I think that’s why we’re gonna see it playing out over the electoral cycle for 2024.
Chaddock: You know, this issue may also split our listeners and your readers, but one thing that in my experience has always united Monitor readers is a great desire to be fair. You know, supporters refer to “medical care for transgender children” or “medical transition care.” Critics call it “experimental medicine” or even “mutilation.” Even the term “trans” isn’t recognized by both sides as legitimate. How do you navigate this linguistic minefield in a way that’s fair to both sides when views are so fundamentally different?
Montlake: In terms of the language, I experience this from both sides of the debate: people trying to push back against how I describe things or my questioning. So there is definitely a linguistic minefield here. What we try to do is to not use emotive or euphemistic language, but to, as clearly as possible, explain what is being debated. And also putting it in a wider context. So when we’re talking about gender care, we make clear what this involves, and also how rare it still is. We’re talking about maybe a hundred or so clinics across the country serving hundreds or thousands of people.
Take for example, this term of “experimental medicine.” A lot of medicines which are used for treatment, for example hormone treatments, which are used by transgender youth and transgender adults, would also be prescribed to menopausal women. It’s the same drug, and the same drug has not been FDA approved in terms of certain trials for certain conditions, but the drug is not considered experimental.
In terms of “child mutilation,” which is a very strong term. If you’re talking about surgery on transgender youth, those under 18, that is incredibly rare. And in fact, a far more common procedure is cosmetic surgery. This happens widely, and this is again, irreversible. This is an elective surgery. But there’s no outcry about those children or those parents approving that kind of surgery. So I think you have to be very careful to acknowledge people’s feelings, but also to see the political motivations behind such labeling. And again, to be fair, when the transgender activists talk about “gender affirming care,” I don’t think that’s a particularly helpful phrase because people aren’t entirely sure what that means. And I think it’s much more helpful to talk about hormone treatment or puberty blockers or counseling or whatever other medical intervention you’re actually talking about.
Chaddock: When you’re talking to people about a very difficult issue with strongly held viewpoints, how do you handle your own sense of fairness in how you ask and process their responses?
Montlake: When I was reporting this story, I interviewed a parent of a transgender child, and that parent had very strong opinions against the Republican legislation in the State House. And at one point said to me, look, this is not a “both sides” issue. There aren’t two sides of this. And, you know, that may be how people feel in that situation. And I said to him: “I understand what you’re saying, that this isn’t a simple “both sides” story. The analog I always think about is climate change, which I’ve also covered. When it comes to climate change, there is an overwhelming scientific consensus that the planet is warming and that we are responsible for that. There is a great deal of debate about the nuance within that, about the pace of change, about the exact mechanisms, about the complex inner workings of the atmosphere. But again those opposed to making any concessions or change to a fossil fuel based economy latch onto that and twist it into a both sides argument.
So when this parent made that point, I did sympathize in the sense that it isn’t a simple, “both sides” argument. It’s not that one side says: “We want to have the right to talk to our doctors and get the right care for our children.” And the other side says: “No, you’re mutilating your children.” Those are two opinions, but there is a broad spectrum within those two opinions, which actually is where a lot of people would go. I think the Monitor’s job is to understand that nuance and to bring it to readers, so that they don’t think that this is a simple, A-vs.-B argument.
Chaddock: Simon, thank you very much, first of all for taking on this topic, and discussing it with us so thoughtfully.
Montlake: Nice talking to you, Gail.
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Chaddock: And thanks to our listeners: You can find more, including our show notes, which include a link to the story we discussed in this podcast, at CSMonitor.com/WhyWeWroteThis. This episode was hosted by me, Gail Chaddock, edited and produced by Clay Collins and Jingnan Peng. Alyssa Britton was our engineer, with original music by Noel Flatt. Produced by The Christian Science Monitor, copyright 2023.
