California teenager Chloe Cole has become something of a star of the movement to deny treatments to transgender youth.
She has given testimony or made public statements in support of anti-treatment bills in Florida, Ohio, Kansas, Missouri, Louisiana, Idaho and North Dakota; appeared on Fox News; and shared a Washington platform with right-wing Rep. Marjorie Taylor Greene, R-Ga.
That's useful for you to know in assessing Cole's latest moment in the spotlight: her filing of a lawsuit against the giant Kaiser Permanente health care system.
Cole's legal complaint, filed Feb. 22 in San Joaquin County state court, accuses Kaiser doctors and other professionals of having railroaded her into gender reassignment treatment and surgery before she turned 18, leaving her with "deep physical and emotional wounds, severe regrets, and distrust of the medical system."
In her public appearances, Cole describes herself as a detransitioner — that is, a person who had second thoughts about transitioning from their gender assigned at birth and has chosen to go back.
She claims, however, that in her case there's no going all the way back — she had a double mastectomy while transitioning from female to male, and says that the hormones and puberty blockers she took along the way have left her with permanent health problems.
It's impossible to know at this juncture how much of Cole's narrative unfolded as she says, how much of what she views as medical malpractice is due to her or and her parents' misunderstanding; her lawsuit is 32 pages of pure accusations. Kaiser, for the moment, can't discuss Cole's case without her express permission because of federal and state patient privacy laws.
That might change when Kaiser files a formal response to the lawsuit, which could be weeks or months from now. For the moment, all Kaiser is willing to offer is a generic statement that it "provides patient centered gender-affirming care that is consistent with the standards of medical care and excellence (and) ... founded on sound research and best medical practices" for all transgender patients including adolescents.
The context of Cole's lawsuit bears close scrutiny. It's part of a concerted right-wing attack on LGBTQ rights, in which the health of transgender youth is exploited as a pretext for bans on gender-affirming care. It resembles the right-wing attack on abortion rights, another movement that cynically masquerades as an effort to improve health care but actually exposes millions of Americans to injury and death for strictly partisan purposes.
In this case, too, the targets are not only the patients themselves, but their families. Treatment bans and efforts such as an attempt by Texas officials to prosecute gender-affirming care as "child abuse" terrify parents seeking to obtain information, counseling and therapy for their children who may be grappling with physical and psychological challenges.
"Their fear is always around accessing the care that kids are already receiving and being able to continue medication they've been on with success," says Maria Bruno, public policy director of the LGBTQ advocacy group Equality Ohio.
Cole is one of a handful of self-described detransitioners who have been flown around the country by anti-transgender activists to speak in favor of treatment bans. Their presentations aim to persuade legislators that second thoughts are common among transgender patients, as though to suggest that gender-affirming treatment is a sham.
In fact, studies indicate that only 1% to 2% of transgender individual "detransition," and that often happens because of discrimination and other social pressures, not because the patients genuinely feel they have made a mistake about their gender identity.
Proponents of these bans assert that puberty blockers and hormones used in such care endanger the lives of adolescents. They say the youths may be going through a phase that they'll soon outgrow and the treatments are based on overly indulgent diagnoses of "gender dysphoria" — that is, the psychological distress caused by "an incongruence between one's sex assigned at birth and one's gender identity," in the words of the American Psychiatric Association.
The truth is just the opposite. Gender dysphoria diagnosis is neither novel nor a fad, as some partisan critics assert. Instead, it's recognized by professionals as a serious medical condition.
"Gender-affirming care and treatment for gender dysphoria has been provided in the United States for decades," says Kellan E. Baker, executive director of the Whitman-Walker Institute, a Washington research center and provider of health services to the LGBTQ community.
These treatments are administered according to professional protocols and guidelines of long standing, Baker says. The standards of care for children prior to the onset of puberty (which happens on average between the ages of 9 and 11) call for "social support," meaning "listening when a kid tells you who they are," he told me.
The onset of puberty "can be extraordinarily distressing for transgender children," Baker says. That's the period when irreversible physical changes emerge that can conflict with the young person's gender. "It's well known that this can cause depression, anxiety, suicidal ideation, and other challenges that can be life-threatening for young people who are going through the wrong puberty."
Drugs can be administered at that stage to delay or pause puberty. "They don't have irreversible physical effects," Baker says. "When you go off them, puberty resumes." Adolescents who suffer from gender dysphoria take puberty blockers "to give them time to work with clinicians, mental health professionals, and their parents to make sure they are on the right track."
Professional guidelines call for hormone therapy — such as testosterone for female-to-male transition and estrogen for male-to-female — to begin around the age of 15 to 16. Surgical interventions aren't indicated for people under 18, except in very rare cases in which dysphoria is so severe that it can't be mitigated any other way. "Typically, surgeries are performed in adulthood," Baker says.
Put it all together, and the bans on such treatments prior to adulthood being pushed by conservatives deny them to people at the moment when they're most in need.
For many patients, outlawing the use of therapeutic hormones until adulthood or the use of puberty blockers on children, as is mandated by laws and regulations passed in some states, condemns them to living with a serious medical condition that could have been alleviated through medical treatment.
"I was a trans kid who grew up here, and I would not have survived if I wasn't able to access the gender-affirming healthcare I desperately needed," Ohio resident Aaron Demlow, 24, told a committee of that state's House of Representatives last May, when it was considering a ban. "Gender-affirming care saved my life at 16."
The proposed ban appeared assured of passage, but failed to cross the finish line before the legislative session expired; it has been reintroduced this year and is again expected to pass and become law.
The minds of politicians and ideologues supporting prohibitions on gender-affirming care are impervious to similar appeals from patients and parents or to the weight of professional evidence favoring treatment. The hearings on Ohio's proposed ban drew 26 proponents and 289 opponents.
Then there's Florida, a state where sound medical science gets obliterated by conservative politics (as evidenced by the state's campaigns against COVID-19 treatments and vaccination).
At a hearing last month by the state boards of medicine and osteopathic medicine, Democratic state Rep. Rita Harris read off a list of 22 professional bodies, including the American Medical Association, that opposed restrictions on young persons' access to gender-affirming care.
"That's quite a group of people to go against and say you don't agree," she said.
The boards voted to confirm a ban on puberty blockers and hormone replacement therapy for minors originally proposed in June, and even removed an exemption for treatments undertaken as part of clinical trials. The state Legislature soon will take up a bill placing the ban in state law.
In June, Florida's Medicaid program banned coverage for gender-affirming care. Last April, the state's crackpot surgeon general, Joseph Ladapo, recommended against puberty blockers and hormone treatments for anyone under 18, a stand contradicting the recommendation of the U.S. Department of Health and Human Services.
Nearly a dozen scientists whose work was cited in Ladapo's memo said he had misrepresented their research, which tended to support, not discourage, those treatments. An open letter signed by 300 Florida specialists in transgender care said Ladapo's recommendation "misrepresents the weight of the evidence, does not allow for personalized patient and family-centered care, and would, if followed, lead to higher rates of youth depression and suicidality."
Cole has addressed public events with right-wingers who have broader agendas, such as opposition to abortion and support of the Jan. 6 insurrection, including Greene and the Proud Boys.
Her lawyers include San Francisco attorney Harmeet Dhillon, a veteran courthouse culture warrior who has brought lawsuits promoting gun rights, upholding voting restrictions, and opposing mask mandates. In January, Dhillon ran unsuccessfully for the chairmanship of the Republican National Committee.
Cole's legal complaint bears all the shortcomings common to initial filings in cases dealing with controversial topics, plus a few all its own.
Her narrative is peopled with physicians and psychologists heartlessly and casually breaching their professional responsibilities. She says Kaiser and its professionals "blindly ramrodded" her into gender-affirming treatment. Kaiser, she alleges, deprived her and her parents of the knowledge they needed to give informed consent to what she describes as hasty life-altering decisions.
Cole's legal complaint incorporates what seem to be misleading or inaccurate descriptions of developments in the gender dysphoria treatment field.
The complaint states that "negative results" from the use of puberty blockers and hormones "caused" the shutdowns of a transgender clinic at Johns Hopkins Hospital in 1979 and Britain's Tavistock Gender Identity Development Service more recently.
Neither assertion is quite accurate.
The Johns Hopkins clinic was closed by the hospital's chief of psychiatry, Paul R. McHugh, on ideological and religious grounds; a devout Catholic, McHugh opposed gender reassignment treatments in principle and maintained, as he put it in a 2016 Wall Street Journal opinion piece, that "'sex change' is biologically impossible." Johns Hopkins shed McHugh's four-decades-old judgments and reestablished its gender identity clinic in 2017.
Tavistock has not been shut down, though it is slated for closure by Britain's National Health Service later this year. Its problems were not related to the medical issues with the treatments themselves, but rather with its being overwhemed, as Britain's lone treatment center, by a torrent of new gender dysphoria cases. The NHS plans to replace Tavistock with several regional centers to improve access for all such patients.
Cole's complaint also describes the conclusion of a 2011 Swedish study it cites as having found that "transition treatment does not improve long-term mental health for transgender individuals."
That's not what the study concluded, however. The study compared the mental and physical health of 324 patients who underwent gender reassignment surgery between 1973 and 2003 to the health of a control group of non-transgender individuals — not to transgender persons who had not undergone surgery.
"No inferences can be drawn as to the effectiveness of sex reassignment as a treatment," the study's authors cautioned. "Things might have been even worse without sex reassignment."
That doesn't surprise Baker and other transgender advocates. "Experiences of discrimination, harassment, violence, rejection get under the skin," Baker says.
"It is very hard to be transgender in a transphobic society. When you see high rates of depression and anxiety among transgender adults, that's the reason."
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