Dear Constituents: A Note from Your [Imaginary] Democratic Politician

Imaginary off-ramps

Photo by hay s on Unsplash

In the spirit of creating off-ramps for Dems—who realize that we need reform of youth gender medicine, but who have invested so much political capital in it that they can’t turn away—I’ve written what I imagine they could say. Edits? Suggestions? Please leave in comments.

Dear Voter:

I’m proud to represent you, and to be a Democrat—historically the big tent party, the party of pluralism, the party that champions the little guy, insists the wealthy pay their fair share, and upholds women’s and LGBT rights.

In this deeply polarized time, it’s easy to lose track of our core values, to be for something just because the other side is against it—and vice versa. Many of the issues facing Americans today, from declining wages to rising addiction rates, are complex and systemic, and require us to look at them from multiple angles.

That includes the issues facing women and trans people. Several historic laws, Constitutional amendments, and Supreme Court cases protect the civil rights of those groups. Title VII of the Civil Rights Act of 1964 prohibits discrimination on the basis of sex (as well as race, color, religion, and national origin). Bostock v. Clayton County, from 2019, ensures that “sex” includes sexual orientation and gender identity, protecting both gay and transgender persons from employment discrimination.

We must admit that, in some cases, the needs, privileges, and rights of women and transgender persons compete. As the pluralistic party, we cannot simply choose one group over another, but rather must work together to create equity and justice for all Americans. We must look beyond party lines to figure out what’s best, which means engaging in difficult discussions about proposed changes to Title IX and to single-sex sports.

We must continue to be the party of science, which means that whenever new evidence is introduced, we incorporate it into policy, and revise as necessary. This is particularly important when it comes to the gender affirming model of care for young people with gender dysphoria, and with young people identifying as transgender. These children and adolescents deserve the best, most evidence-based care possible.

Over the last year, as Republicans have tried to ban medical interventions for this cohort, we’ve watched as several European countries worked to alter their approach— based on evidence, and not ideology or politics. Countries like Finland, Sweden and England have created new guidelines and models of care that insist on careful evaluation over a long period of time; psychological support as the first line of intervention; and long-term follow-up of any minor who receives gender medical interventions, often in the context of a study.

These countries shifted approaches because they saw that the existing body of evidence was of very low quality; that more young people than expected were regretting their changes and detransitioning; and that the cohort requesting medical interventions were quite different from those on which that existing evidence was based. They realized they simply didn’t know enough about who would benefit from, and who would be harmed by, medical interventions.

We had hoped that the American medical associations would follow suit. Instead, they have continued to insist that their model is without flaws. Our Republican colleagues have used the blunt instrument of bans to fire up their bases and flex their muscles, often terrifying the people who believe they need these interventions, who see them as life-saving.

Research reveals that while Democrats continue to support trans people’s civil rights, we’re much more divided within our party on gender-affirming care. Indeed, a number of Democrats have broken ranks to support that legislation, preventing minors from accessing medical interventions like cross-sex hormones or surgeries until adulthood. They did this not out of bigotry, but because they have become better informed.

I have heard from many of my constituents that, while they don’t support bans in general, they do believe that the youth gender medical industry needs scrutiny and reform. We are dedicated to upholding the civil rights of all people, no matter how they express gender, no matter how they identify, no matter what sex they are.

In the coming months, we promise to listen to all our constituents on these matters, to create an environment where we can have respectful debate, to invite you in to work with us on these issues, and on defeating Donald Trump. We look forward to hearing from you, and welcome your input.

Sincerely,

Your Imaginary Democrat