Joanna Wuest — Studying the Anti-Trans Ideology
Assigned Media interviews Assistant Professor Joanna Wuest.
by Riki Wilchins
Joanna Wuest is Assistant Professor of Women's, Gender, and Sexuality Studies at Stony Brook University where she writes and teaches on sexuality and gender politics and law, health, and political economy.
Assigned Media: In your article for The Nation titled, “Trans Medicine’s ‘Merchants of Doubt’” you open by saying that, “For much of the past decade, it seemed like the arc of history bent toward justice for transgender Americans.” But then came the backlash, which you describe as “not an organic opposition but incredibly coordinated from the most powerful groups in conservative politics.”
Joanna Wuest: That was derived from a study with Brianna Last in which we found a “network of agents of uncertainty” working across medicine, law, and politics to create this narrative that trans or gender affirming care for minors was not safe or effective but dangerously uncertain. Alliance Defending Freedom (ADF) was essential to that network from early on, coordinating behind the scenes and recruiting dissenting and fringe medical voices.
It's important to understand that for many years ADF’s anti-trans efforts failed. Its anti-trans kids narrative in the context of bathroom reforms repeatedly lost in the federal courts, and in 2017 the US Supreme Court declined to hear an ADF bathroom case that would have resulted in a national ruling. It wasn't until the last few years when they amassed enough resources and clout and just brute strength in the federal judiciary and in state legislatures, that ADF was really able to push bans on pediatric care.
AM: In their report, “Manufacturing the Doubt that Fuels the Network,” the Southern Poverty Law Center documents the ADF’s use of its network to pump out reams of anti-trans pseudoscience, which unfortunately then framed the public debate over care. Both you and SPLC show how this is the same playbook borrowed from the Right’s attempts to undermine the science behind fossil fuels, tobacco, and Covid-19. Your study “Agents of scientific uncertainty,” examined 375 citations used in litigation in the first gender affirming care ban, which was passed in Arkansas.
JW: Yes, we found that there were four expert witnesses defending the gender affirming care ban. Three of them did not do gender affirming care or even treat folks with gender dysphoria. One was a plastic surgeon who operated out of a strip mall clinic. And all of four cited out of date research going back to the 1960s, which said most children are going to desist.
AM: Some of these anti-care clinicians and groups are pushing "watchful waiting,” which sounds very due-dilegency-y—like you’re carefully monitoring the kid before reaching a decision—but in fact the decision has already been made to deny care?
JW: The emphasis on how “watchful waiting” is used is important because it distorts the fact that it was developed decades ago at the University of Amsterdam and originally allowed for medical transition and/or social transition after a period of waiting. But the folks using the “watching waiting” now are not advocating for any intervention. They’re getting a lot of mileage out of being able to cite decades of practitioners who have used the term, but they mean something very different.
AM: Advocates for pediatric care, many of whom are relying on lots of clinical experience and the latest peer review studies, are increasingly being attacked from the Right as not being in favor of Evidence Based Medicine. It sounds pretty damning.
JW: Evidence Based Medicine is a whole paradigm for evaluating research and applying it to clinical practice. But it privileges randomized controlled trial studies as the pinnacle, with a large sample including a control group that gets a placebo and a treatment group that gets the treatment or medicine. So if you can't show that you have done an RCT then you're much more likely to be deemed practicing medicine that is not Evidence Based.
AM: There are tens of thousands of medications, many with multiple uses and tens of thousands of medical procedures. Not every one can be tested by RCTs which are extremely expensive. And, as you point out, they can be unethical: In the ER you can’t assign half of heart attack patients to a treatment group and the other half to a control group that just gets a placebo and they see your heart medication is really effective.
JW: Yes, exactly. As Brianna said, with cigarettes we don't randomly assign people to smoking and non-smoking groups for RCTs, because that would be incredibly unethical.
AM: In your article for the polling firm PRRI, Anti-Trans Attitudes in Political Context, you show how opposition to trans people using the correct bathroom was only 35% in 2016, but it had jumped to 54% just 7 years later in 2023. A shift of 19% is pretty extraordinary by itself. But you also find that most of this came among Republicans, whose opposition nearly doubled, from 44% to 80%.
What scared me was that you also found that independents’ opposition soared from 37% to 56%—again 19%. So the Right did a really good job of igniting a social panic around bathroom use, once again.
JW: Yes, and in an incredibly short time. A few years ago, not even a majority of Republicans were opposed. It’s astounding. In 2016 major corporations and sports leagues boycotted North Carolina over its bathroom ban law, the national conversation was about equality, rights, and discrimination.
But the Right has been extremely effective in reframing trans rights as trans health, and then trans health as uncertain and dangerous. They’re tapping into a long tradition in this country of sex panics in politics.
AM: One of the great things about PRRI is their focus on the intersection of religion and politics. A PRRI poll in 2021 found that just 21% of white evangelicals were comfortable knowing someone trans. And a 2022 poll found that white evangelicals were the only religious group in which a majority felt that trans acceptance had gone too far and moved too fast.
You can make the argument that there’s not really a political war against trans being waged by Republicans, but a religious war being waged by white evangelicals.
JW: I think there's a huge religious element here. The contemporary Republican Party has been significantly shaped by alliances that big corporate donors and political strategists made with white evangelical leaders and organizations going back to the 1970s. They'd been attempting it for longer; but it’s in the 1970s where we really start to see the groups like Heritage Foundation and Council for National Policy cultivating the white evangelical voters that now make up much of the GOP.
But even this GOP will temper on trans issues when they get push back—particularly from business organizations. We saw that between 2016 and about 2021, when care bans, sports bans, and all sorts of anti-trans laws failed to pass state legislatures because regional chambers of commerce and major corporations pushed back. It's a complicated story about how the floodgates open the following year in 2021 and then 2022, with the cascade of anti-trans laws in state legislatures.
AM: In another piece for the Nation, Banning Trans Health Care Puts Young People at Risk of Harm, you call out the use of a small but prominent group of professional detransitioners who are moved around the country to testify in legislatures and courtrooms. And you cite Jack Turban—whom Assigned Media had the honor of interviewing recently—who has shown that detransition is often due to family pressure or social stigma or discrimination, not to regret.
JW: I agree 100% that detransition is not synonymous with regret. I'm a fan of the idea of retransition instead of detransition, which stresses that we think about all sorts of things in our life where we make decisions which change our life going forward. So some people who stop taking gender affirming care might be transitioning to some other phase of their life. And we know that many of those folks do not talk about “regret” the way that we see in these anti-trans narratives.
AM: In many studies youth have been coded as “detransition” when all they did was decide they weren't a trans boy or a trans girl but gender fluid, genderqueer, or nonbinary. Which is important for kids: a 2023 Washington Post/KKF poll found that only one-third of Gen Z trans kids identify as binary boy/girl.
JW: Yes it's remarkable how poor the popular language is for talking about whether a kid is trans or not. Care opponents want to pit gay or gender nonconforming kids against trans kids in order to demonize medical intervention.
AM: In your article you make an important point: conservative justices are focusing on health risk in cases like Skrmetti but these same justices have long track record of being very selective about what kinds of health risk taking is good or bad, from using ivermectin to treat Covid 19 to supporting the right to refuse to wear a mask in the middle of an active epidemic.
JW: There’s a complete double standard when it comes to trans care. It also extends to ignoring risks of mental health struggles and increased risk of suicidality when care is denied. And when conservatives attacked health regulations and mask wearing during COVID, they also claimed that the evidence was low quality or there was no RCT. It’s a very selective use of Evidence Based Medicine conservatives are using.
AM: I want to pivot to your book Born This Way, in which you dissect this whole narrative in nondiscrimination law which favors immutable characteristics, like race, sex, or sexuality. You document how this is limited and has also amplified the search for a biological basis for LGBTQ+ identities.
JW: The Born This Way narrative has backed us into this corner because advocates have to argue against uncertainty, that there is some scientifically validated, biological element that explains why someone is gay or trans. So in a 2016 Supreme Court brief, the ACLU argued that a student was not trans by his “mere assertion,” but because he had these diagnostic papers. The danger is we get relegated to a world where to be trans, is to always be asked to show one's papers.
In addition, the cis/trans binary language that we're in makes it sound like cis people are incredibly certain of their gendered feelings and they don’t experience any uncertainty over how they're going to embody masculinity or femininity. This is stuff that you've talked about for decades that rigid gender norms oppress everyone, not just trans people.
AM: In your book, you note that the born this way narrative also doesn’t work for identifications that aren’t legible in the way the law requires. That made me think of kids who are nonbinary, genderqueer, or genderfluid, which are not so much the announcement of a fixed gender identification as its absence.
JW: Yeah, I think that's true. It's an incredibly limited way of approaching civil rights law.
AM: But the inevitable question is, what would be the alternative?
JW: There are federal judges who have ruled that the immutability of a characteristic does not require biological evidence for it. We don’t say that religious affiliation is immutable, but we provide nondiscrimination protections for it.
You could also argue that forcing someone out of their sexual orientation or gender identity has been proven to be extremely harmful—including increased suicidality—as an alternative to justifying legal protection based on their immutability.
AM: It’s ironic that this Supreme Court, which is determined to push legal recognition for religious belief in every facet of public life, is denying the idea that one's immutable sense of gender identity deserves the same respect. Before we end, I have to say that I’m a little jealous that both you and Jack Turban have both been attacked by the Manhattan Institute.
JW: What’s interesting about the Manhattan Institute and its anti-trans campaign is that they're not a Christian nationalist shop, they’re ostensibly libertarian. But their anti- care campaigns are a sort of proxy war against two opponents: professional medical associations—which they see as cartels with an improper kind of influence—and on health care costs. So you shouldn't trust the AMA—but then it's also universities. Christopher Rufo writes a lot for the Manhattan Institute and his opponents are very clear: he’s using these attacks on trans studies in the humanities and colleges and universities. But they don’t have a first order commitment to attacking trans people. He's using an attack on gender affirming care to go after the teachers unions and higher education.
AM: Thank you so much for your time.
Riki Wilchins writes on trans theory and politics at: www.medium.com\@rikiwilchins. Her two last books are: BAD INK: How the NYTimes SOLD OUT Transgender Teens, and Healing the Broken Places: Transgender People Speak Out About Addiction & Recovery. She can be reached at TransTeensMatter@gmail.com.