Kaiser Permanente Concedes Gender-Affirming Care Without a Fight: But You Can Fight Back

Introduction

Kaiser Permanente recently ended gender-affirming surgeries for patients under 19 years old. They join Stanford Medicine in a wave of healthcare institutions who have abandoned science and obeyed in advance, instead of standing up for their patients in the courtroom.

Republicans are following the fascist tactic of peeling off thin slices of civil rights. Their stated goal is to end all gender-affirming care – to trap transgender people in bodies that cause gender dysphoria. Restricting gender-affirming surgeries sets a precedent for restricting more common and essential treatments, like hormone therapy. The age cutoff of 19 years old sets a precedent to restrict care for all transgender adults.

Any institution that surrenders to budget blackmail encourages future bullying. Who’s next – disabled patients? Undocumented or immigrant patients? This article is a call to stand together.

Strategic Context

Trans Healthcare is Bodily Autonomy

Should the government force women to incubate and give birth? Should the government imprison people in their assigned gender? Abortion and trans rights are both issues of bodily autonomy. For transmasculine people, in the same body.

Anti-abortion and anti-trans legislation are products of the same political coalition, using the same scripts and tactics.

– Jules Gill-Peterson, Professor at Johns Hopkins

By Alfred Twu

If you are concerned about abortion access and other issues of bodily autonomy, then solidarity with transgender rights is part of a winning coalition.

It’s propaganda

Today’s trans moral panic is manufactured. Much of what you have heard about trans people are lies crafted by well-funded right-wing propaganda outlets. They experimented with trans issues for years until they found the most emotional ones. This bad-faith debate is politicial, not scientific, to demonize a vulnerable minority for power.

Republicans use the transgender rights issue to sabotage the left. They use it for sound-bites, such as with the oft-asked “what is a woman?” They drag us into debates about whether to sacrifice a given right of a vulnerable minority – which sets us up to sacrifice the next, and the next, and the next, because fascists cannot be sated. Energy we spend fighting each other over trans rights is energy not spent opposing GOP fascism. They use this issue as a liberal-seeking missile.

Mythbusting

I will quickly address some common myths about gender-affirming surgery spread by Republican propaganda.

Science Supports Gender-Affirming Care

Despite significant institutional barriers, trans people have been medically transitioning for the last hundred years. (And have existed in various forms for thousands.) Trans children have been treated for many years, with the support of their parents and the strict evaluations and supervision of medical specialists. After half a century of serious study, the medical consensus is in: genderaffirming care is life-saving medicine.

The Panic Is Cyclical

The first modern moral panic about trans people was in the 1930s, when literal Nazis burned Dr. Magnus Hirschfeld’s pioneering research in transgender medicine. The moral panic in the 1970s and 80s shuttered well-established gender clinics such as Johns Hopkins. Society did not collapse from advances in transgender rights before and after these moral panics.

It’s Rare

Gender-affirming surgeries are rarely practiced on minors.

Safety

By the standards of surgeries in general, gender-affirming surgeries are safe.

Experimental

Gender-affirming surgeries are not remotely experimental. Modern genital surgeries have been practiced for almost a century, since the first vaginoplasty and phalloplasty were performed in the 1930s. Masectomies and gonadectomies are millenia old.

Regret

Gender-affirming surgeries are indeed significant and permanent bodily modifications. That’s kind of the point – for patients with gender-dysphoria, they provide life-saving relief. The regret rate is approximately 1% or below 1% – extremely low for surgeries in general and major life decisions more broadly.

When Republicans talk about protecting children from regret over genderaffirming care, they are concern-trolling.

Gatekeeping

A lay-person listening to certain media outlets might have the impression that doctors are handing out or even pushing gender-affirming care. This myth is an affront to the millions of trans people who have struggled to convince reluctant doctors to treat them.

Gender-affirming care in general, and especially surgeries, are tightly regulated by medical standards of care. For a minor to get a gender-affirming surgery requires the approval of doctors, surgeons, mental health professional, parents, and the insurance company. It takes many sessions over years and a full-time gender transition before surgery is even on the table.

What evaluation should be done before providing gender-affirming care? For minors especially, it is a scientific question to which medical professionals continue to refine the answer (e.g. the WPATH Standards of Care eased surgical approvial requirements in version 8). They will do so best without interference from Christian nationalist government theocrats who despise gender freedom and bodily autonomy.

Double standards

Most gender-affirming procedures were invented for cis people. Conservatives tend to have no problem with medical procedures that bring a cis or intersex child closer to the societal norm for their assigned gender, whether it is androgen blockers and estrogen for polycistic ovary syndrome or surgery for under-developed or ambiguous genitals. They have no problem with doctors surgically forcing a arbitrary sex on an intersex child.

Because gender dysphoria is a protected class under California nondiscrimination law, it is illegal to deny procedures to trans people that are provided to cis people. (Attorney General Rob Bonta is suing).

The stakes

The stakes of this moral panic are life-and-death. LGBT suicides are up. It’s about dignity, the right to a body that is comfortable to inhabit and doesn’t automatically mark you for discrimination. It’s government intrusion into the private decisions of families and doctors and, for patients who are 18 or 19, the agency of adults.

Responses

•      The San Francisco Kaiser Nurse’s Union protested the move KQED, ABC7

•      State Senator Scott Weiner condemned the move at the same protest

•      California Attorney General Rob Bonta has actively pushed medical institutions to not obey in advance, that it is discrimination under California law to withold gender-affirming care from trans people (and not cis people):

1.    In a past statement, Bonta warned medical institutions that denying gender-affirming care is unlawful discrimination

2.    He is part of a lawsuit defending states’ rights to regulate genderaffirming care from Executive Order 14187 and the Department of “Justice”

Call to action

Thank California Attorney General Rob Bonta

(916) 210-6000

My name is __________. I am a constituent, and my zip code is _____. I am a member of Indivisible San Francisco.

I believe that transgender rights are human rights and that gender-affirming care is life-saving medicine. Thank you for defending trans Californians from the Republican administration’s cruel federal overreach in Executive Order 14187. I ask that you condemn the healthcare providers who chose to capitulate to an executive order with uncertain force of law over following California state law and human decency.

Thank State Senator Scott Weiner

(415) 557-1300

My name is __________. I am a constituent, and my zip code is _____. I am a member of Indivisible San Francisco.

I believe that transgender rights are human rights and that gender-affirming care is life-saving medicine. [Optional: Say why this is important to you.] Thank you for your swift condemnation of Kaiser, after they halted gender-affirming surgery for children and young adults. I urge you to defend all gender-affirming care from federal overreach, including by supporting Attorney General Bonta, protecting medical institutions from Republican intimidation, and by discouraging them from obeying in advance. I ask that you condemn the healthcare providers who chose to capitulate to an executive order with uncertain force of law over following California state law and human decency.

Send a letter and/or Boycott Kaiser

Now is a good time to switch from Kaiser. If you are on Kaiser through Medi-Cal, you can change providers at any time (1-800-430-4263). San Francisco Health Plan covers excellent UCSF providers and chosing them pushes back against the for-profit privatization and enshittification of our healthcare.

If you do this, be sure to send them a letter telling them why: solidarity with the trans community and the bodily autonomy movement.

You can also send a grievance form to Kaiser by mail about their discrimination.

Pressure Kaiser

Join protests at Kaiser. We will let you know when the next ones come up.

Educate

The next time trans rights come up in conversation, share what you learned from this article.