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The complexities and nuances of transgender coverage

Transgender people are increasingly in the news, and not always in a good way. 

Trans people constitute just a tiny percentage of Americans, but the community and its place in society have become a flash point in political and cultural debates. State lawmakers have introduced more than four hundred bills targeting trans people this year alone—including some that restrict gender-affirming care for adults as well as minors, limit antidiscrimination policies, and prohibit changes in official documents. All this amid calls for the eradication of “transgenderism.” 

It’s a story that will likely only heat up as the 2024 election cycle gets underway and as trans people become more visible in public life. But it’s also a story that requires nuance.

What is the science behind gender-affirming care? (For that matter, what is gender-affirming care?) Which experts and data should you trust, and whose voices should you hear? Who is protected and who is harmed by proposed legislation, and at what cost? Who should get to decide what a transgender adult—or child—gets to do with their life and their body? 

These are not unanswerable questions. But too often, journalists fail to ask them, or to examine their answers in depth. 

While there have been some great stories on the subject, many publications have made serious missteps—not just errors in balance or accuracy, but lapses in news judgment. And those newsroom decisions matter, particularly at national outlets: officials in several states have cited New York Times coverage to justify policies restricting gender-affirming care. Style guides and other aids exist, but correctly printing trans sources’ names and pronouns should be the least of an editor’s worries. 

Here, then, are some suggestions about how news organizations might want to think about coverage going forward:

Whose voices are heard, and is anyone missing? It may sound obvious, but reporting on news that affects trans people should include those trans people. If a story focuses on the effects of new laws to restrict minors’ access to gender-affirming care, for example, it should highlight people who can personally attest to what those restrictions materially mean.

Stories that involve children often necessarily involve their parents; children may not be able to speak for themselves, or families may have privacy or safety concerns. But a parent’s experience of gender-affirming care for their child (or the lack thereof) is not a substitute for a conversation with an actual transgender child. If that’s not possible, one proxy could be to speak to adult trans people who can discuss their experiences as minors.

Just as journalists covering the lives of gay teenagers should avoid seeing the story solely through the eyes of heterosexual parents, those covering the politics of trans inclusion should prioritize speaking to whichever group of people is most directly affected. Their feelings may differ markedly from those of the cisgender people in their lives.

What is framed as “normal” versus “dangerous”? Articles on gender-affirming care often start with the premise that hormonal and surgical interventions come with risks, and some young people have irreversibly changed their bodies in ways they have since come to regret. This is a real concern, and detransition is a real phenomenon (more on that below). 

But to focus only on the added risks imposed by gender-affirming care assumes a fallacy: that there is no inherent risk to not providing this care to adolescents in need of it. The real question, as with any medical intervention, is whether the potential benefits outweigh the costs. 

We can’t yet rule out the possibility of unknown future side effects from the COVID-19 vaccine, to use an analogy. But we know enough about COVID-19 to know that doing nothing (and remaining unvaccinated) is riskier than getting a shot. It isn’t enough to compare the experience of a vaccinated person who had side effects with that of one who didn’t; it’s critical to look at the population that was never vaccinated at all.

A person’s gender identity may be fluid, but puberty is an up-or-down switch. The changes brought on by the body’s sex hormones are lifelong, and “undoing” them later may require invasive medical care—a tracheal shave for trans women or mastectomy for trans men, for instance. 

For many trans people, the horror of gender dysphoria is watching your body develop characteristics that seem alien. Left to run its course, puberty can leave the same “deep physical and emotional wounds” some anti-transition activists say they’ve suffered.

Puberty-blocking drugs can not only spare a young person that emotional pain in the moment, but can also circumvent physical pain later in life. Doctors consider these factors when recommending them. 

It can be easy for journalists to assume that choosing no treatment poses no added risk, or that delaying treatment comes with no cost. But what is “natural” is not necessarily safer. And the necessity of gender-affirming care has been a medical consensus for years, even as actual practices have evolved.

Is the story proportional? Trans people are a minority of a minority. A 2022 Gallup poll found that just 10 percent of self-identified LGBTQ people are trans, or less than 1 percent of the broader US population. More young people overall now identify as trans compared with older generations, per data from the University of California, Los Angeles. But trans people still only account for about 5 percent of adults younger than age thirty, according to a 2022 Pew survey. Those facts can get lost in news stories.

Further, not all trans people will seek medical interventions; a Washington Post survey of adults found that less than a third had used hormone therapy and far fewer had undergone surgery. Only a tiny fraction of young people who socially transition later return to identifying as their gender assigned at birth, per a 2022 study. Available data suggests transition-related regret is very rare, and even patients who stop transitioning may do so for societal or familial reasons unrelated to their own internal identities. 

Yet many, many column inches have been dedicated to an incredibly small population of young “detransitioners.” As journalists, we know our audience’s attention is finite; when reporting on societal phenomena, we must discern signal from noise. Is our readers’ time well-served by this hyperfocus? 

To draw a parallel to another public health story: A landmark 2020 study found that more than 95 percent of women who’d had abortions stood by their choice five years later. Would simply contrasting a person who regretted their abortion with one who didn’t offer readers a balanced understanding of the issue? 

What’s the political context? When covering legislation that targets trans people or gender nonconformity generally, do not take a policy’s purported intent at face value. Some bills stand little chance of being signed into law and are purely messaging documents. Others may have stated objectives, like stopping “child abuse,” that deceptively frame what they will actually do. 

This is hardly unique to trans issues. Consider Republican-led “born alive” bills. These proposals are ostensibly meant to stop the killing of babies who survive abortion attempts—which is already against the law. Functionally, though, they would force doctors to perform futile medical interventions on infants born with fatal abnormalities. 

Likewise, the recent Missouri order requiring healthcare providers to track their trans patients for fifteen years may seem prudent, but it’s a standard few clinics could meet. And a new Florida measure would specify, among other things, that only a “physician” may prescribe gender-affirming hormones or procedures in the state, and then only in person—language that serves to bar access for the many Floridians who would rely on nurse practitioners or telehealth services for their care.

When reporting, ask: Is this piece of legislation a response to a real concern? Can its backers prove it is correcting some kind of harm or misconduct? (Are trans girls or women really dominating sports? Are trans-affirming teachers really letting students use litter boxes?) And if the answer is no: What is the actual purpose, and who is lobbying for it? 

Are sources quoted and described appropriately? Trans inclusion was used as a cultural wedge issue in the 2022 midterms, and political actors have a vested interest in getting their views on trans people in print. Exercise caution when quoting nonexperts on technical topics like hormones or psychiatry. And do not attempt to balance a story by uncritically quoting false statements—for instance, that genital surgeries are performed on prepubescent trans children.

Relatedly, do not assume that neutral-sounding organizations are in fact neutral. The American Academy of Pediatrics has been firm in its support of gender-affirming care. The American College of Pediatricians calls it an atrocity. They may seem similar, but the former counts some sixty-seven thousand clinicians among its members, while the latter is a fringe group numbering around seven hundred.

A track record of partisan statements needn’t be grounds for excluding a person or group. But readers should understand who has which ax to grind. This context has been missing from some high-profile trans coverage in the New York Times—a problem other journalists highlighted in a letter of complaint earlier this year. 

Would this sound bad if it were written about some other group? Think critically about how trans people, as a minority, are described. If substituting another marginalized group—say, “Black” or “Chinese” or “deaf”—makes the story sound off, you might want to rethink the premise. 

And be mindful of euphemisms, as you would be when discussing other groups. A “safe space for biological women” may seem innocuous, but a “safe space for white women” would imply there is something inherently unsafe about places nonwhite women are allowed. Interrogate whether those ideas are worth airing.

Finally: Does the story treat trans people as fully human? Even asking that may seem hyperbolic, but most of the above list can be boiled down to a question of autonomy

It can feel difficult to divorce conversations about transgender identity from the high rates of suicidality among trans people. And the disproportionate number of trans people also diagnosed with autism, for example, may feel like a confounding factor. Recent polling has found a majority of Americans believe a person’s gender can never change from what is stamped upon them at birth. All of this can leave readers wondering if it’s even possible for trans people to consent to what critics deride as “mutilation.”

I am trans. I am also a person. My personhood is independent of how well “gender ideology” polls. My will to live is not a simple coefficient of how many hormone shots and tasteless comments I’ve received. While the words trans people use to describe ourselves have changed, as all language does with time, transgender identity is itself an age-old phenomenon, long predating the current backlash and certain to outlast it. 

We exist. What is being debated—in the op-ed pages, over the airwaves, and in statehouses—is whether we should get to control our own lives, and to what extent cisgender people should control them for us. These are the stakes. To lose sight of them is to lose the very essence of this story.  

Graph Massara is an editor based in San Francisco. He most recently reported on viral misinformation for the Associated Press, during which time he consulted with AP Stylebook editors on LGBTQ terminology.

Members of the Transgender Journalists Association contributed to this article. Learn more about TJA here.

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