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Emails Reveal How a Hospital Bowed to Political Pressure to Stop Treating Trans Teens

www.propublica.org Emails Reveal How a Hospital Bowed to Political Pressure to Stop Treating Trans Teens

The Medical University of South Carolina initially said it wouldn’t be affected by a law banning use of state funds for treatment “furthering the gender transition” of children under 16. Months later, it cut off that care to all trans minors.

Emails Reveal How a Hospital Bowed to Political Pressure to Stop Treating Trans Teens

The Medical University of South Carolina initially said it wouldn’t be affected by a law banning use of state funds for treatment “furthering the gender transition” of children under 16. Months later, it cut off that care to all trans minors.

One Saturday morning in September 2022, Terrence Steyer, the dean of the College of Medicine at the Medical University of South Carolina, placed an urgent call to a student. Just a year prior, the medical student, Thomas Agostini, had won first place at a university-sponsored event for his graduate research on transgender pediatric patients. He also had been featured in a video on MUSC’s website highlighting resources that support the LGBTQ+ community.

Now, Agostini and his once-lauded study had set off a political firestorm. Conservative activists seized on one line in particular in the study’s summary — a parenthetical noting the youngest transgender patient to visit MUSC’s pediatric endocrinology clinic was 4 years old — and inaccurately claimed that children that young were prescribed hormones as part of a gender transition. Elon Musk amplified the false claim, tweeting, “Is it really true that four-year-olds are receiving hormone treatment?” That led federal and state lawmakers to frantically ask top MUSC leaders whether the public hospital was in fact helping young children medically transition. The hospital was not; its pediatric transgender patients did not receive hormone therapy before puberty, nor does it offer surgical options to minors.

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  • I understand your point of view, it's good that there's a lot of care taken to make sure the mental impact of transitioning is minimal, but the point is this is a huge amount of work to help someone try and cope with "being" something that doesn't align with what what they were born and biologically formed as. It's a noble sentiment, but we should be approaching the whole issue in a way that helps people realize that they don't have to change to be themselves.

    • we should be approaching the whole issue in a way that helps people realize that they don’t have to change to be themselves.

      That is literally the first thing the majority of transgender people try. Usually for years if not decades, before they finally accept who they are and transition.

      • I guess my question is why doesn't the medical field try harder to actually properly fix the suffering they're experiencing instead of just helping them with the part of the process that keeps them buying hormones for the rest of their lives to fight their own body's hormone production and sometimes involves painfully mutilating themselves?

        • You've asked this same question repeatedly, with other people providing reasonable research links, anecdotal evidence, etc.

          It's hard to avoid concluding that this is just some very civil trolling on your part. I appreciate that you're trying to be civil, but perhaps think, do some more reading and reanalyze your conclusions vs the boring solution of digging in one's heels and irritating people.

        • Because they have tried everything else, it didn't work. We've done all the things you are asking. We have tried every therapy you can imagine. It's not effective.

          You are working on the assumption that there is some other treatment that works that we are just ignoring. What exactly do you think it is?

          The truth is that transition works, it alleviates distress, and it's a very simple and safe treatment option.

          • I'm sorry if it came off that way,

            I'm well aware that there's not much else available because the medical field clearly doesn't care enough to give you a more effective treatment option. I remember hearing about a drug that eliminated the feeling of gender dysphoria, but now I can't even find anything about it on the internet, and to be completely honest, it feels suspicious, because even the idea of innovating toward simply treating the core emotion of gender dysphoria is shunned, even though it's the most rational and straightforward treatment anyone could have.

            The point is that a medication that could eliminate the root cause of dysphoria should and possibly did exist, but clearly something is strange with the world if even the idea of directly fixing someone's mental anguish is seen as hateful and bigoted. You should not stand for those keeping you away from genuine relief and contentness, instead of this half baked excuse for a treatment that is destructive to your body, emotions, and fights your hormones.

            • You should not stand for those keeping you away from genuine relief and contentness

              You are right. I will not stand for that. Which is exactly why I I ignore people like you. Because YOU are the one trying to keep trans people from the relief and contentment that transition is known to bring.

              The relevant facts of the matter are:

              • A treatment exists.
              • The treatment works.
              • The treatment is safe.

              The only reason you are arguing is because you personally don't like the treatment.

              And your opinion on other people's healthcare is irrelevant, and something you should keep to yourself.

    • You kind of have it backwards. When you're trans there's a lot of work that you have to do to try and align with your physicality. The mental aspect is often very isolating because you don't see yourself as having very much in common with people of your phenotypic sex. Like you can be friends with them and feel close emotional connections but your brain doesn't register as them being like you the same way it does with cis people of your gender. Your brain also rewards you with a huge dopamine hit when someone actually recognizes who you are inside. It's a feeling like being invisible and nobody even knows you're there and then someone actually notices you.

      Seriously a cashier just automatically coding me as my gender makes my whole gorram week. It's like someone shot sunlight directly into my brain and I get to carry that around for a few days.

      The jealously of physicality is also not super subtle. I am riddiculously jealous of people with fairly unremarkable features. We're not talking movie star levels of beauty just- has a sex characteristic I want. I did not medically transition and chose to keep my birth sex characteristics because my partner really isn't attracted to the opposite set of characteristics. I value that romantic attachment enough that I would easily take a bullet for them. If I could make that sacrifice I figure essentially living in a body I wish every day I didn't have to live in tolerable. But so much has to be going right in my life for this to be okay.

      But even then sometimes it's a lot. Like I know I will never not be hideous to myself. I might very well die having never really liked the way I look. I have a massive issue going to weddings and formal events because when I try to look good to myself it brings to light how even when I try it's so very far off from what I wish I could look like on a good day. People are actively mislead from how I would prefer to be treated, referred to and recognized because of my body and putting up with that takes additional energy and frustration daily. If I don't want people reminding me of the body I am in I have to tell everyone I meet to please use different pronouns for me and think of me differently so I can try my best to not be reminded of my body.

      A lot of people when they come out as trans do so because they are already tired of trying so hard. A lot go through a stage where they try to be the best version of their birth sex they can be to try and make it work and find it has done nothing to make them happy. Part of why so many of us are complete hot messes when we socially transition is because by the time we give up trying to pretend to be cis we realize that we are dying from being so invisible and isolated from the people who we see as being the closest to us. That nobody actually knows us.

      Even with my close friends who know my deal I sometimes see the wall that keeping this physicality maintains. Your brain does a lot to code everyone you meet as male or female and that translates unconsciously into how people reacts to you. Your brain prioritizes that information and we trans folk intimately know this. We can tell who is humouring us as best they can because they want to do the right thing by us and who actually has the switch flipped to their brain properly recognizing us as who we are... There is a cognitive load on the people who deal with us and we recognize that and a lot of that is based on our physicality. We see that cognitive work cis people go through lessen as we change. We see it in ourselves when we deal with other trans people who transition around us. (There is actually a kind of really funny thing with trans people who pass perfectly as a cis person where the transphobes have to fight the cognitive dissonance in the opposite direction. You see it in the micro hesitations they when they use a pronoun associated with somebody's birth sex and they get around it more by saying "they and them" more often, something we refer to as "the coward's they" because they are actively fighting their own brain's mechanisms that register the proper gender to maintain their meaness)

      We recognize that gulf in you but we can't change you. The only thing we have the power to change is ourselves.

      • i'm genuinely sorry you have to deal with that. The world would be a better place if there was a greater focus on helping people feel comfortable in their own skin rather than seemingly embracing those cold feelings and letting trans people suffer through things like that.

        I understand your viewpoint and that you understand how many people feel, and wish that core discomfort you feel could just be destroyed and replaced with the warmth that should fill you without having to make compromises to yourself or others.

        You and everyone else deserve to be happy the way you are, and the medical field is doing you wrong by focusing on the wrong part of the issue, and I'm sorry so many people are so hateful toward those who suffer from that without understanding what they're going through. I'm sorry if what I'm saying is coming off as hateful, but I just want to see that core, inner coldness be replaced with happiness without people having to change themselves, and without that issue being ignored or glorified.

        • Yeah, you don't get it. Even when people try it's hard because they aren't the full problem. We react to our own bodies and we have an inner sense of gender. That's hard to communicate to a lot of cis people because they don't have an inner compass that registers gender. A lot of them figure their sex means basically nothing to them and it's like trying to explain color to the blind when you have an inner sense. There are cis people who do experience gender euphoria and deep connection to their gender but they are kind of rare and a lot of people don't really explore something when it works.

          Moreover... The medical field actively resists people who want to medically transition. We have to prove beyond shadow of a doubt that it is what we want before anyone even starts considering it. YOU focus on the wrong part of the issue. You are not our therapists and endocrinologists. You aren't a researcher or a parent or partner of a trans person. Our medical transitions aren't your business. You have been lead to believe you know better than we do because when you only listen when other cis people talk about us in ways that register your confirmation bias from being cis that feels true to you because you are primed not to see us as reasonable. You have probably been informed we are delusional or crazy and thus unable to make our own informed choices. You want to try and save us from ourselves... But you do not know us you have just been lead to believe your opinion is reasonable because no joke being trans is really hard to empathize with properly.

          When you say " I just want to see that core, inner coldness be replaced with happiness without people having to change themselves" you basically are just saying "I just wish you weren't trans. " If someone gave me the option of changing my gender to match my birth sex just so that I was happy in this body, I would not do it. Because gender lies so close to the core of who you are to just change it would be so fundamentally violating to my sense of self I would essentially stop being me anymore. For as long as I remember my gender has consciously or subconsciously colored every relationship and social interaction I have had in my life. It is in the bones of how I think about myself and my life. For all the frustration of not having the body I want this IS me. Changing my body is nothing by comparison.

          • saying that I wish you weren't trans by wanting to see your anguish disappear simply doesn't compute to me. From what I've been hearing from each of you, being trans is a response to what is being clearly acknowledged as discomfort with yourself.

            The point is that you and everyone else said they are not content with their sex, which is an issue because you shouldn't have to feel like the opposite sex to feel they way you are.

            If you're a biological male, you should not have to feel that you must label yourself as female in order to present yourself the way you feel and vice versa. In fact, having to feel the need for a gender separate from your sex shouldn't even be necessary, because you should be able to just present yourself without essentially stating you're a different sex.

            Men can be as stereotypically feminine as they want, and women can be as stereotypically masculine as they want.

            The point is that you shouldn't have to present yourself just the way you are and then justify it to society by labeling yourself as something other than your sex in order to conform with it.

            Just be yourself. The issue is that you seem to think you have to justify it by labeling yourself differently.

            • That is the thing though, we are not just tomboys and femboys. It is not on you to tell us what should and shouldn't be nessisary. You are not us. That you believe in your heart that you are an authority is something you need to sit yourself down with and really think about because your experience does not represent the entirety of humanity here and you keep demonstrating to me that you have zero idea what it going on with people like me while trying to tell me what I am. You can't change my position on what I am, I live it every day. When you tell me something that is conflicting directly with the experience I have and the experience of the community where I have a bunch of close friends to compare notes to it comes off as more than a little self centered. To you gender is just something you perform. It does not connect to anything deeper because for you it's basically just clothes and affect. For you gender is superficial and that is part of the experience of being cis so that really doesn't help. The majority of cisness could probably be best described as not as a strong conception of gender that aligns with your body but an absence of strong feelings about gender at all.

              If I change my clothes people still treat me as my birth sex. Even the ones who are trying their damnedest to do right by me their brain is still coding me as the other sex and that is disappointing at a basic level. Being trans is not just about dress up. Gender is NOT just something we perform for your benefit. It is also not fully about pain. We do routinely have to tell cis people about our pain to try and break past the inertia to get people to help us we routinely have to prove to you that we are suffering an untolerable level of permanent unhappiness because otherwise you just prioritize your baseline of not having to do even a little mental work on our behalf. It's easier for you to rebel against having to take on that cognitive load rarely when you meet one of us than it is to accept someone needs this.

              But talking about pain doesn't cover the joy when we actually get to catch glimpses of ourselves in the mirror because we get to see some glimmer of us in there. It doesn't cover the deep connection we feel immediately with other human beings who react to us as though our gender is a given. It doesn't account for the fact that so many of us literally dream we are not in the body we were born in so we wake up in the morning wanting something that feels so good and natural when we are asleep. A thing about transition is that so often trans people only find their very first actually fulfilling romantic relationships once they are on the other side of their transition. You can't really love someone deeply when you don't like the person you are and your partner doesn't actually recognize what you want and need. It isn't about reducing pain, it's about being happy in a way that resonates with who we are.

              And we understand gender expression. Ho boy do we. There are a lot of binary trans people who wish they didn't have to conform to societies binary customs but if they don't then people code them as their birth sex and treat them like their birth sex. There are plenty of trans femmes who desperately envy tomboys for their ability to wear comfortable clothes and still be recognized as their gender.

              What makes a trans person feel trapped inside themselves and invisible to other people is the lack of recognition they are their gender. Not just that their body looks like it though we do have strong feelings about our bodies for the sake of them as well. Dysphoria and euphoria, the two halves of the experience of transness, are very good at telling you exactly what the heart wants. It screams it at you even when it doesn't make a lot of sense. Longing is a killer. Because of my circumstances I basically just altered my clothes and style and it sucks. Every time I pass a reflective window or speak and hear the timbre of my voice it makes me lose confidence. I used to pass so effortlessly when I was a kid so I get that sense of loss of something that made me so happy that I just won't experience again. Strangers still automatically gender me incorrectly about 90% of the time which makes me feel like I am a fucking human in a chimpanzee body trying to prove to them I'm human and everytime they treat me like a chimp I just don't want to be around people just that little bit more.

              Identify exists in two parts your conception of yourself and other's conception of you. It's basic Heigel. Transness is mostly dealing with the disconnect of these two halves of identity. The constant is our own identity. Gender is a primary key to how we conceptualize ourselves. From everything you have said I can tell that gender is not a component of how you conceptualize yourself... but that's just comfort because of absence. If you are completely ambivalent about something you aren't the best spokesperson for people who cannot live without that thing. Trans people work hard to express gender because if nobody recognizes that in us they do not see us and if we are not seen we are not understood and if no one understands us we are the truly alone.

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