Week in review: Magneto was right
The breakdown
Monday, Republican Florida state representative Webster Barnaby made headlines after an unhinged tirade during a hearing on HB1421 where he referred to trans people as “mutants”, “demons” and “imps”.
Rep. Webster Barnaby (R-MO) on April 11
Tuesday evening, North Dakota Gov. Doug Burgum signed a bill into law that bans trans girls from participating in athletics from kindergarten through college. Meanwhile, that same Tuesday and again on Wednesday, states advanced bills that would massively increase liability for gender care providers in an effort to dissuade or financially lock out providers from accessing insurance.
The bills are written in such a way that if a patient were to change their mind for any reason over the next ten years— or in one case in perpetuity, providers could be on the hook for hundreds of thousands of dollars. This liability would be incurred regardless of whether an assessment was done or malpractice actually occurred.
By Thursday, Missouri state Attorney General Andrew Bailey announced an emergency regulation imposing nearly impossible hurdles for trans people of all ages to access HRT or surgery. They would impose waiting times of 3 years, require 15 months of nonstop assessment and impose behavioral health clearance requirements that are so stringent it would ban access for most people outright.
Bailey has been engaged on an all-out war against trans people in Missouri for over a month now, having set up hotlines and a website for “concerned citizens” to report gender care providers— specifically focusing on clinicians at The Washington University in Saint Louis (WUSTL) medical center gender clinic.
Bailey’s emergency regulation mirrored the tactic of Texas’s own genocidal A.G., Ken Paxton. In February 2022, Paxton directed the state Department of Family and Protective Services to investigate all parents of trans youth whereby any affirmation or non-rejection of trans identity would be considered “child abuse”.
Paxton’s policy also provided inspiration for a bill advanced in Florida on Thursday that would allow the state to remove children from affirming parents, even if the child in question is just passing through the state. You know, a kidnap bill. HB1421 would authorize the investigation and arrest of gender care providers as well.
That same day, Missouri advanced the state legislature’s version of the “Save Adolescents From Experimentation” act to codify a total ban on youth care into law.
Late Thursday evening, after a truly heroic filibuster that lasted almost a month, a GOP senator in Nebraska returned from sick leave, in turn tipping the balance of party representation in the state senate such that a newly re-established supermajority allowed them to break the filibuster. In speaking on the senate floor after her colleagues voted to override the filibuster, real life superhero State Sen Machaela Cavanaugh broke down sobbing, profusely apologizing to all of the trans youth who are going to suffer as a result of this cowardly move by her fellow senators.
Friday, April 14, former president Trump addressed the annual NRA convention in Indianapolis, where he promised in a campaign speech that if re-elected he would direct the FDA to review “whether transgender hormone treatments and ideology increase the risk of extreme depression, aggression and even violence”. The recurring theme of “violent trans extremists” was a popular talking point at the convention.
Friday evening, after weeks of sustained harassment, doxing, boycotts, vitriolic speeches and calls for the execution of Dylan Mulvaney for appearing on a beer can and doing a promotional spot on Instagram at the request of the company who sent her a personalized commemorative beer can, Anheuser-Busch CEO Brendan Whitworth issued a statement that simultaneously says nothing at all while also clearly apologizing for the crime of affiliating with trans people in any way.
The statement comes the day after bomb threats were called in at Budweiser factories, including one in Los Angeles prompting the LAPD bomb squad to sweep the factory.
Whitworth’s statement “We never intended to be a part of a discussion that divides people” is a puzzling one. For while it’s perhaps a good principle if you ignore the fact that the other side of this issue is a group of people who doesn’t want an entire other group of people to be allowed to exist at all. It is a quintessential paradox of tolerance issue. Whitworth’s enumerated list of white, working-class archetypes tips the company’s hat to who it sees as the primary audience of its brand: law enforcement, military, sports fans, and “hard-working Americans everywhere”.
And while people more inured to the contradictions of capitalism might see this as a necessary step to stop issues at facilities and save corporate face, Whitworth’s statement is particularly galling when you realize that Anheuser-Busch’s stock is still up almost 5% YTD, and no meaningful drop has actually been observed in share price.
The only people who win in this case are people like Matt Walsh and somehow-not-yet-dead human cold sore Kid Rock, who shot four cases of Bud Light with an automatic rifle on Tiktok to express his feelings about trans people.
Steps you can take.
If you live in a state impacted by gender care bans and you want to start HRT, make an appointment now. In states like Missouri, existing HRT patients will for the time being be able to access HRT after the ban takes place. Planned Parenthood of Missouri has stepped up tremendously, and is now offering pop-up clinics around the country to help get people with this process.
One thing that’s clear is that we need to seriously consider the possibility that HRT supplies will become harder and harder to access. It truly is time for people to stock up on HRT. Even in states where bans aren’t being proposed yet, it’s clear that supply chain disruptions are going to happen quickly as more and more prescribers drop out of gender care, as is already happening in Missouri in the wake of Bailey’s announcement.
One thing to note is that many of the instructions given to injectable HRT patients include instructions to discard vials after 28 days. This guidance is based on evidence that when used in unsanitary settings, vials can become contaminated with harmful bacteria over time. If you use injectable medications, talk to your doctor about how long your vials actually last. Many prescribers say that it is possible to get months out of a single vial safely if you follow contamination control instructions.
If you take HRT of any kind, set a calendar invite or a reminder on your phone to refill your prescription as soon as it’s available. It can take a little trial and error, but most insurance companies will allow you to refill when you have only a week left. Even a couple of days adds up over time, and you can soon create a safety net supply if things hit the fan.
If your doctor thinks it’s safe, you might want to consider switching to implantable hormones. Puberty blockers last years in the body, and some versions of Testopel can last as long as six months! If there are court remedies for these bans, they will take time, and buying time may be essential.
Fellow providers! Now is the time to seek reciprocity licensure in most-impacted states. Especially, if your home state has sanctuary laws containing non-cooperation clauses instructing law enforcement to disregard extradition or investigation requests from states with anti-trans laws.
Do you have a couple of dollars to send to people trying to flee states like Texas and Missouri? While it’s not feasible for most people to move out of state— nor should they have to, there are families making this difficult decision right now and they could realy use your help. I’ve aggregated GoFundMe campaigns on a linktree.
Put pressure on the Biden administration.
There are a couple of actions Biden could take right now if he actually wanted to— a dubious proposition given recent actions, but here's a list of things Biden could do literally right now.
Re-instate telehealth exemptions via HHS for providing care across state-lines - during the start of the COVID-19 pandemic, the U.S. Department of Health and Human Services issued an order lifting restrictions on telehealth to allow providers to meet remotely with more patients. HHS as well as state regulatory agencies also loosened reciprocity licensure requirements. As many behavioral health providers must be licensed state by state, special applications for established providers seeing clients in other states allow us to apply to have our home state board examination count in lieu of the host state’s own exam.
Direct the FDA to expedite approval or seek an emergency use authorization of gender care medications like androgen blockers, puberty blockers/GnRHa and HRT. A critical talking point on the right, as well as a crucial component of state arguments for restricting gender-affirming care is that such medications are “off label”— despite the fact that much of all medicine is off label, or was designed for a completely different use. While sometimes new uses do indeed get FDA approval, it’s often less about science and safety than it is about profit. Drug companies will re-patent medications to capture new “markets'“ (capitalism is gross) like when guanfacine, originally an anti-hypertensive, was rebranded as Intuniv and sold as ADHD medication. Similarly, prazosin, an alpha blocker (α1-adrenoceptor antagonist) is used as an anti-hypertensive, but also now commonly prescribed for night terrors associated with PTSD.
Instruct DEA to remove testosterone’s Schedule III classification - largely due to fears in the 1980’s around “roid rage” testosterone is a Schedule III controlled substance, which makes obtaining testosterone prescriptions quite difficult for trans people. While it’s fairly trivial for cisgender men to be prescribed testosterone replacement therapy for low-T, transgender men are held to a much higher standard which can lead to shortages.
Intervene in Missouri - Missouri is an absolute emergency right now, and there are steps the administration could take right now to intervene.
Instruct OCR to investigate patient privacy and civil rights violations by staff who knowingly shared confidential patient information with the media to manufactured the panic at WUSTL.
Instruct the Department of Justice to seek an injunction against A.G. Bailey, as well as to investigate the ongoing harassment of trans people and gender care providers by Bailey’s office. Bailey’s office has set up hotlines for people to report gender clinics, and is actively seeking information on providers while threatening gender care providers with criminal charges. Bailey’s emergency regulation is simply not legal, and while that’s rarely stopped anyone before, the DOJ needs to be on the ground yesterday to respond lest this turn into a cascade of other states.
