ACLU Attorney Chase Strangio on Transgender Rights

CHRISTIANE AMANPOUR, HOST: Now, as America approaches its midterm elections, the question of transgender rights are also in the spotlight. Multiple states including Texas and Alabama have passed some sort of restrictions affecting trans people. Chase Strangio, deputy director of Transgender Justice at the American Civil Liberties Union, joins Hari Sreenivasan now to discuss misconceptions about transgender health and rights.

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HARI SREENIVASAN, CORRESPONDENT: Christiane, thanks. Chase Strangio, thanks so much for joining us. First, let’s kind of set the table a little bit here. When we start to talk about this topic, especially in the heated political climate that we’re in right now. I think it’s good to have just some basic understanding at some terms that we might have in this conversation. So, for example, what is transgender medical care? Because a lot of times, it just is synonymous with surgical intervention, and that’s not true.

CHASE STRANGIO, DEPUTY DIRECTOR FOR TRANSGENDER JUSTICE, ACLU: Thank you so much for having me and for starting us off with that important framing. I do think a lot of times when we’re talking about health care for transgender people and particularly, for adolescents, there are a lot of distortions. So, when we’re talking about what’s often referred to as gender affirming medical care, this is medical treatment that had been developed by medical associations like the Endocrine Society, like the American Medical Association and the American Academy of Pediatrics affirming a set of guidelines. And these guidelines include care like puberty suppressants. So, that is treatment that pauses puberty for individuals who are still in puberty and that is a certain type of treatment that has been used for a very long time to treat other conditions and is totally reversible. And then, there are hormone therapies that are used for both adolescents and for adults. Things like testosterone for transmasculine people, estrogen for transfeminine people. And again, these are terms that are used to treat a lot of other conditions and are specifically part of the protocol for treating patients with gender dysphoria. And then, there are surgical treatments that are usually reserved for adults. In some cases, trans adolescents have surgery like top surgery for trans masculine patients or breast augmentation for transfeminine patients. But again, these surgeries, when they are available are for older adolescents and are the types of surgeries that we see for other individuals as well. But what we hear often are these really incendiary and distorted arguments about care — surgical care being performed on trans adolescents, which is largely not what we’re seeing in this context.

SREENIVASAN: Is this something that children can seek out or is this something that is usually done with the parental consent?

STRANGIO: This is only done with parental consent. In the United States you — you know, by and large, cannot consent to your own medical treatment until you reach the age of majority, which is usually 18. This is care that is incredibly conservative in the way it’s provided that requires substantial oversight and parental consent. So, when we’re talking about accessing things like puberty blockers or hormones for trans adolescents, parents are involved. The parents are the ones consenting to the treatment not the young people themselves. So, these are treatment decisions where you have a doctor who is seeing a patient and their family, recognizing some sort of medical need, recommending a course of treatment that in and of itself is highly regulated with endocrinologist, psychologists, social workers, maybe general practice pediatricians, and then, it is the parents who are weighing the risks and benefits as to what happens with pediatric care. And then, deciding in conjunction with the doctor and the young person to move forward with this particular treatment. This is not care that young people themselves are consenting to because that’s just simply not how medical care is provided in the United States.

SREENIVASAN: Last week, different medical organizations, the American Academy of Pediatrics, the American Medical Association and the Children’s Hospital Association released a letter to Attorney General Merrick Garland. And they wanted essentially an investigation into the ongoing threats against doctors who provide gender affirming care to trans children. What are you hearing from doctors?

STRANGIO: Yes. I mean, absolutely. Unfortunately, what we’re hearing across the country is that medical providers who treat transgender adolescents in particular, whether at gender clinics or through university programs or affiliated with children’s hospitals are facing a host of threats that are coming largely from social media, but as we saw on the case of Austin Children’s Hospital, there were bomb threats called into the hospital. The hospital, entire hospital had to shut down. And ultimately, what is felt as with the case of the abortion context and those access in care at places that provided abortion, whether they were receiving abortion or not, is that patients are then children going to those places because you are scared. You are scared both for your physical safety but also, emotionally to have to manage that type of in your face protesting when you’re trying to get the medical care that you need. And it’s important to remember that this is all part of the same strategy. The very same lawmakers that stand up in state legislatures to restrict trans health care often in the very same legislative hearings are trying to be on abortion. These are interconnected fights. Challenging the ability of people to self-determine their bodily autonomy and their identities and to live freely. And so, when we think about the coming weeks, months, years ahead, these fights are incredibly interconnected. We are going to see a tax not only abortion and trans health care as we have already seen with all of these bills attacking both types of medical care, we’re going to see attacks on access to contraception, we’re going to see attacks on access to same-sex marriage and adoption. So, we know these kinds of attacks on our autonomy are coming. But they are deeply, deeply interconnected.

SREENIVASAN: How much legislation is happening now and kind of put it in context for us and whether it’s sort of normal or not? And what is the range of what these pieces of legislation across multiple states are trying to do?

STRANGIO: Yes. I mean, what we’ve seen for the last six, seven years is an increasing escalation in legislative attacks on trans communities. This started in large part in the aftermath of the United States Supreme Court decision in Obergefell v. Hodges, which was the case that struck down bans on a marriage equality for same-sex couples. So, in essence, you have the Supreme Court ruling in 2015, a major piece pro-LGBTQ legal paradigm shift occurs and the opposition immediately shifts to trans people. And then, in 2016, we start to see the proliferation of anti-trans bathroom bills. That’s when we saw to HB2 in North Carolina and you saw hundreds of those bathroom bills across the country. The context of the bill is to sort of shift it overtime over the last six years, we went from sort bathrooms to locker rooms and then, what we’ve seen more recently are attacks on the ability of trans young people to play sports, the ability of trans young people to access health care and then, the ability of trans people to be referred to by their pronouns in schools. These are sort of the three areas where the legislation has really focused over the last two years. In the context of health care, the escalation has been quite staggering. Because you actually had across the country a relative increase of access to medical treatment. This was consistent with the increase in recognition by medical associations that this careless effective and safe for this population. And as that care access increased, we had a backlash that coincided with this backlash from the marriage equality decisions. And we are seeing these attacks on health care for trans adolescents which started in apart on restrictions on insurance coverage and then, what we’ve seen quite rapidly is rather than just restricting who pays for the care, we’re seeing these outright bans. And in the case of say, Arkansas, which was the first state to pass one of these bans in 2021, it’s ban has a set of civil penalties regulating the doctors themselves. Then we see in Alabama, which passed a ban in 2022. That ban has a felony provision that authorizes imprisonment of medical providers and possibly parents up to 10 years in prison. And of course, in Texas what we’re seeing is the governor and attorney general directing the child services agency to investigate for the child abuse if they’re providing this medically recommended treatment to their adolescent children. And so, it goes from the civil regulations, which, in essence, to ban care but all the way up to threatening to remove children from their homes if the parent is providing this treatment.

SREENIVASAN: When we talk about access to medical care, I mean, there was NIH report back in 2020 that said, 82 percent of transgender individuals have considered taking their own life. So, you know, right now, when you hear that statistic and you hear legislators say, why don’t we just wait for these children to be adults, until they’re 18, to be able to have whatever it is type of care that they want. What’s the risk here?

STRANGIO: I mean, I think there’s two things to say. First, the risk, of course, is that they’re not going to turn 18. The risk, of course, is that there is simply not going to make it. We’re talking about a population of people who is experiencing incredibly high level of distress and for whom there are interventions that can alleviate that distress. And so, take those interventions off the table is just a devastating outcome in a population of people who are suffering and struggling so much. At a time when, by the way, it is hard to be a young person growing up right now. We are dealing with pandemics. People have their education disrupted. And so, the last thing that so many people need is to have the government attacking them in this way. And then, the other thing I’ll say is that they claim that it’s about young people and that there are just restricting access to care for young people. But we’re starting to see the ages creep up. We’re starting to hear about bans for adults. And so, I think that too is quite a disingenuous argument from the opponents of LGBTQ people. I don’t believe they’re going to stop with adolescents. I think their goal is to take over care from all of us. And in any event, even just talking about the young people, they’re suffering, they’re struggling. Banning this care is a completely egregious and intrusive use of government power and resources.

SREENIVASAN: So, I know the ACLU has posted a few stats online. It says that 16 bills have been passed in states like Florida, Arizona, Oklahoma, Iowa, Louisiana, South Carolina, South Dakota. I keep going on. And 27 are still awaiting decisions. So, is there a key target? Are they basically a copy paste job of what’s work in previous states or are different states taking kind of more restrictive or less restrictive measures?

STRANGIO: Yes. When we look at the national landscape of anti-trans bills and most of the states that had passed laws have passed laws that are banning trans women and girls from sports, again, in states where, at times, they cannot point to a single trans girl who is playing sports or in the case of the states like Kentucky, they can point to a grand total of one. And so, we have those types of bills that are being pushed around the country as well as these health care bans. And I’m sure we’re going to see new types of restrictions emerging in the 2023 legislative session. But it is a copy and paste job. I mean, these are not constituent indriven (ph) pieces of legislation. I do not think that the individuals in Arkansas are sitting around thinking the most pressing thing for them to be doing at this moment with so many things going on is to ban trans girls from sports when nobody can even identify one trans girl who is playing sports. These are bills that were drafted by national organizations that have decades long history of lobbying against anti LGBTQ — lobbying against LGBTQ people, restricting the rights of people — restricting reproductive rights. And again, you have model legislation that are shipped out to lawmakers across the country and then, pushed through exceedingly anti-trans and conservative legislatures. And what we’re seeing is increasingly those bills are becoming a law. And when it comes to the health restrictions that had previously been unsuccessful because even, for example, Governor Hutchinson in Arkansas who had signed many pieces of anti-trans legislation thought this is a bridge too far. This is intruding into the family and fundamentally unhelpful and dangerous ways. And he vetoed the health care ban. But the legislature overrode his veto.

SREENIVASAN: There was a Gallup poll a while back that said some 70 percent of U.S. adults said that it should be legally recognized, same sex marriage. So, I think we’re at a point where same-sex marriage is something that is not a great sort of political weapon to start using against one party or another. And then, what’s interesting is how many people agree that there should not be any discrimination against trans people, but when it comes to the context of sports, that support wanes a little bit when it comes to figuring out exactly what should be done about how a competition should fare.

STRANGIO: I think when we look at polling, the example of same-sex marriages is a perfect one because so much of how people respond to these questions, about legal rights and protections for LGBTQ people has to do with how comfortable and familiar people are with the population of people we’re referring to. And even though now people tend to think that same-sex marriage is relatively non-controversial, if you look at the early 2000s, that was the main way that people were driving out conservative voter base was through bans on marriage equality. I grew up in the ’80s and the ’90s in the 2000s. And certainly, it was not uncontroversial to talk about access to same sex marriage. And you would hear similar things like, well, I don’t have any problem with gay people, I just don’t think they should get married, or I don’t have a problem with gay people, I just don’t want them in my locker room. So, these are not new ideas. In essence, what you have is general support for the proposition that there shouldn’t be discrimination and then, something that makes people uncomfortable in part because they haven’t had any exposure to the issue or to it at the side of individuals. I think the more people see trans young people for who they are, they will stop picturing the sort of othered monstrous figure of Lebron James in a dress playing sixth grade basketball and instead, recognize that we’re just talking about another set of young girls who want to play on a sports team with their peers. This is not about some group of people coming into dominate. This is not about some scary unknown people who’s going to take away rights from others.

SREENIVASAN: Why do you think this is an issue that we’re even talking about? Is this because we’re heading into a midterm cycle? Is there essentially a political advantage for framing this as a defining issue?

STRANGIO: I mean, I think it’s two things. I absolutely think the timing is relevant. I think that the fact that it’s something — the fact of the midterms are this year and then, there is a presidential election in 2024 means that we’re going to see the escalation and attacks on trans people, an effort to mobilize opponent (ph) base rather than it being tied to some serious set of the policy concerns that people have. I think it’s opportunistic election year tactics. That said, I also think there is groups of people who generally believe that the idea that you can have autonomy over your choices with respect to reproduction, with respect to sexual orientation and with respect to gender identity is deeply troubling and the idea that people have that type of freedom is something that should be constrained and curtailed. And so, there are people who have a fundamental ideological opposition to the notion of gayness or the notion of transness and we’ve seen that from time. And in that opposition, it’s a desire to establish a very sort of far-right political agenda. And we’re seeing around the world, for example, if you look at places like Brazil or Hungary, you can see that the rise of far-right governments was tied to this sort of so-called attack on gender ideology and the idea that we have to control norms (ph) of gender in order to consolidate power in certain political systems. And so, there is an ideological piece of this that is part of sort of global political project that is shifting governments to the right. And then, of course, there’s just the opportunistic drive to turn out voters in the midterm election here.

SREENIVASAN: This is roughly a population, about 1.6 million people or so in the United States now, and that’s still a less than 1 percent of the population. So, I guess, coming into a midterm, we’ve got all these incredibly pressing issues. How do you get people to get motivated, to — that this is an important issue, that this is part and parcel of what is at stake?

STRANGIO: So, I would say, first and foremost, everyone should care about those who are experiencing marginalization, who are facing attacks just because we should care about our fellow human beings. But separate and apart from that, you should care about the attacks on trans people if you care about your access to reproductive health care, if you care about your access to libraries, if you care about robust curriculum for your schools, if you care about the ability to provide medical care to your children in states that decide that they don’t want to support full free access to medical care. And so, ultimately, it’s not going to stop with trans people. If anything, trans people are the canary in the coal mine, as we’ve seen over and over again, around the world. So, ultimately, we should be in this fight together. As well as the fact that they’re using trans people to mobilize voting based to erode (ph) everyone’s rights.

SREENIVASAN: Chase Strangio of ACLU, thank you so much for joining us.

STRANGIO: Thank you so much.