Over the last 20 years America has become more socially liberal on almost every issue.
But transgender rights has become an exception, a place where the culture war burns hot as public opinion shifts rightward — on specific issues like transgender participation in high school sports and general questions on what really defines sex and gender.
My own sense is that Americans broadly support the liberties of transgender adults to live as they wish, and may not support some of the moves the Trump administration is making to limit legal rights.
But I also think many people have become extremely skeptical about issues involving trans-identifying children. And I also think there’s a widespread sense that open debate on some of these issues was discouraged, that people with doubts or anxieties felt pressured not to raise them.
My guest this week, Chase Strangio, has been at the forefront of the activist push on these issues — for instance, as the first openly transgender American to argue before the Supreme Court. Our conversation is about legal strategy, political backlash, the Trump administration, and where this cultural fight might go. But it’s also an experiment in arguing about these issues directly, looking for common ground and understanding but also fruitful disagreement, across a divide that’s likely to be with us for some time.
Below is an edited transcript of an episode of “Interesting Times.” We recommend listening to it in its original form for the full effect. You can do so using the player above or on the NYTimes app, Apple, Spotify, Amazon Music, YouTube, iHeartRadio or wherever you get your podcasts.
Ross Douthat: Chase Strangio, welcome to Interesting Times.
Chase Strangio: Thank you for having me, Ross.
Douthat: We’re going to talk about where the fight over transgender rights is going. We’re going to try and get into some deeper philosophical waters. We’ll see how that goes.
But I want to start with your own legal work, because you were a lawyer on two of the biggest Supreme Court cases on transgender rights. In the first case, you were on the winning side. In the second one, you lost. Both were 6-to-3 decisions.
I thought we’d start by just having you talk through both of those cases as a way of grounding our conversation.
The first one is Bostock v. Clayton County. What did that case ask the Supreme Court to decide?
Strangio: Bostock v. Clayton County, Ga., was actually three cases that came up to the Supreme Court together. The facts in those cases were simply that two gay men were fired from their jobs when their employer learned that they were gay, and one transgender woman was fired from her job when her employer learned that she was trans.
By the time the cases got to the Supreme Court, the only question was whether or not Title VII of the Civil Rights Act’s prohibition on sex discrimination included prohibitions on discrimination and employment because someone is gay or transgender.
When it reached the Supreme Court, it was a question of pure law whether Title VII covered discrimination against L.G.B.T. people. And our argument was that it is sex discrimination to fire someone for being gay or to fire someone for being transgender.
The argument went: If a man comes to work and says that he married Mary over the weekend, that’s totally fine. But if a woman comes to work and said she married Mary over the weekend and is fired, it’s but for their sex that the firing took place. That is a form of sex discrimination prohibited by the statute.
Similarly with transgender status, if an employer says, “Everyone named Mary, come to my office.” There’s four Marys at the office. Then they say, “Mary, who had a birth-assigned sex of male, you’re fired because you can’t come to work as Mary.” The argument was, it was because of sex. That is prohibited under the plain language of Title VII.
In a 6-to-3 ruling, written by Justice [Neil] Gorsuch, the court ruled in favor of the employees who had been fired.
Douthat: Gorsuch and [Chief Justice] John Roberts both joined the decisions. So, it was the four liberal justices who you would expect to be sympathetic to those arguments, and then the two conservative or right-leaning justices. Why do you think they both joined and Gorsuch wrote the decision?
Strangio: We litigated that case using a straightforward textualist theory that we thought would appeal to Justice Gorsuch, who is an avowed textualist.
That went basically: It does not matter what Congress intended in 1964 in terms of the applications of the law, what matters is the words that they used. And they said no employment discrimination because of sex.
As commentators have often talked about with respect to this case, the shadow justice in the case — who was obviously not in the case because he had died — was Justice [Antonin] Scalia. Both the majority and the dissent were trying to channel who was approaching this case most like Justice Scalia.
Justice Scalia had written a famous opinion called Oncale v. Sundowner Offshore Services Inc., in which he said that same-sex sexual harassment is prohibited by Title VII, even if that was not one of the intended consequences when Congress passed Title VII in 1964.
So, our argument was: Look at the words of the statute. No discrimination because of sex. You don’t have to decide what sex means. That was not what the case was about. We said, whatever definition you want of sex, the answer still holds that these individual employees were fired because of their sex.
I think that appealed to a textualist approach to legal interpretation. Justice Gorsuch methodically went through the Supreme Court’s cases interpreting Title VII, and this fit, I think, squarely within it.
Douthat: Just to stay with the details of the would-be textualist decision. In the case of the transgender person, the idea in that argument that the court accepted is that someone who is born biologically male and goes to work and presents as female is being discriminated against because someone who is born as a biological female could present as female with no issue.
What essential manifestations of transgender identity are covered?
Strangio: Well, in a sense, it’s not even necessarily hinged to transgender identity. What it’s hinged to is: Can you do something that someone of a different sex could not do?
Douthat: Right.
Strangio: It could be if I went to the ACLU and said “I’m Chase.” And the ACLU says “No, because you were assigned female at birth” — but someone assigned male at birth could come to the ACLU as Chase, that would also be an example of sex discrimination prohibited by Title VII. I don’t have to declare a transgender identity for this logic to apply.
In the case of Aimee Stephens, the case that was at the Supreme Court. She had worked for this funeral home for many years and had written a letter saying, “This is who I am. I have struggled with it. I have thought about it for a long time, and after a vacation, I’m going to come to work following the dress code for women and using the name of Aimee.” That was the manifestation she articulated.
But if she didn’t say she was transgender and she had said, “I want to come to work looking less like a traditional man,” and they said, “Well, you can’t do that because of x” — I think that also articulates a theory of sex discrimination that Title VII recognizes.
So, it wasn’t actually hinged to sexual orientation or transgender status as such. It was just recognizing that in the circumstances before the court, the individuals were fired because of their sex.
Douthat: Let’s go forward and talk about United States v. Skrmetti, which was argued last year and decided just this year. This was presented to a slightly different, but similarly divided, Supreme Court. It was a challenge to Tennessee’s ban on certain forms of care, what gets called gender affirming care, for transgender adolescents.
What was the argument before the court there?
Strangio: As you note, there’s a Tennessee law at issue here, and the law prohibits puberty blockers and hormone therapies — only when they’re prescribed to treat gender dysphoria in transgender adolescents.
And if I could just take a brief moment to say what gender dysphoria is —
Douthat: Yes.
Strangio: Because I think that can be helpful for understanding the case, since we have both the legal doctrine and then the science that’s underpinning a lot of it.
So, gender dysphoria is a condition that is characterized by clinically significant distress that flows from the discordance between a person’s gender identity — the core of their understanding of their gender — and their sex assigned at birth.
One of the ways that this condition is treated is through medical interventions that aim to minimize that very serious distress. When minors are treated with these medications, it is done with the consent of their parents and the recommendation of their doctors.
So, in Tennessee, these were medications that were available to treat gender dysphoria in both adults and adolescents. Tennessee passed a law that categorically bans these medications. That leaves families like our ultimate clients in the case without access to medical care in their home state for their minor children.
We sued Tennessee, and we made two legal arguments. The first was that these bans on medical treatment, because they hinged the prohibition on the medication on an individual’s sex, violated the equal protection rights of transgender adolescents. So, a similar argument to the one that we were talking about with respect to Bostock.
Then we made an argument on behalf of the parents, that these laws infringed upon the fundamental rights of parents to direct the medical care of their minor children. This would be a right that is found in the substantive component of the due process clause of the 14th Amendment.
Those were the two claims that were raised in that case. By the time it got to the Supreme Court, what would become United States v. Skrmetti, only the equal protection claim was before the court.
Douthat: Just to be clear, when we’re talking about care, in this case for gender dysphoria, we are specifically talking about drugs that delay or halt puberty?
Strangio: Yes, pubertal suppressants — the medications that halt puberty after the onset of puberty. And then hormone therapy — whether it’s a 16 or a 17-year-old, who is then receiving hormone therapy to undergo either a typical male or typical female hormonal puberty.
Those were the two sets of medications that were at issue in the case.
The way the Tennessee statute drafted the prohibition was to say that medications like these can be prescribed only when they are consistent with sex. So, when we were at the Supreme Court, our argument was focusing on that language as a sex classification under the Equal Protection Clause.
Douthat: Right. And you lost.
Strangio: We did.
Douthat: And you lost the two justices, specifically, who had written and joined the decision in Bostock. Can you gloss in a completely fair and evenhanded way why they ruled the way they did?
Strangio: I want to say first that it was a really hard decision to decide what to do here when we lost at the appeals court. The reality for our clients was devastating; these were parents who had watched their kids suffer, who then had found a medication that was helping them. And I think everyone in the case agreed that this was a context in which there are kids suffering.
So then the disagreement is, well, what do you do about it? And the parents, in this case, our clients, found something to do about it. They worked with their doctors, they learned a lot about the condition. They waited years in many cases before doing any interventions.
We were watching health care be taken away from families across the country, and at the same time, we were looking at options in which you accept a series of losses and care remains banned in 50 percent of the country. Or you go to the court and say: Even if you think there’s a justification for this ban, you should agree with us that it’s based on sex.
Because unlike in Title VII, there’s a two part inquiry. This was under the Equal Protection Clause because it was the government.
The first part is what is the basis by which the government is making a distinction? Is it based on sex or is it based on something else? And if it’s based on sex, then it just means the government has to carry their burden to show that that use of sex is justified. And this is what’s called the levels of scrutiny under the Equal Protection Clause.
So, our main argument to the court was: You don’t have to decide if Tennessee’s law is constitutional or unconstitutional, but we want you to reverse the lower court’s decision that it wasn’t based on sex. That was ultimately what we did and what we tried — and they didn’t agree with us.
The reason that they held that the law was not based on sex was that they thought that it was a classification based on medical use. We wouldn’t dispute that. It is also a classification based on medical use. If you are prescribing puberty blockers for early onset puberty, you’re treating something different than if you are providing it for gender dysphoria.
Douthat: In these cases, you are prescribing it to both male and female children, right? It didn’t say you can only prescribe it to male children or you could only prescribe it to female children.
Strangio: That’s right. But I would say that’s not the reason we lost, although that was part of it.
Douthat: OK. Why did you lose?
Strangio: I think it’s important to explain why that’s not the reason, which is because the Equal Protection Clause does protect individuals. There are examples where the court has said for peremptory strikes, when you’re striking jurors, you can strike as many men or as many women. But if you’re doing it based on sex, it’s impermissible. So, it’s not a group-based protection, it’s an individual one.
And we thought — and I think we were right, the court obviously disagreed — that the medical use imposed a sex classification. That John Doe, our client, couldn’t get testosterone because his sex assigned at birth was female and he could get testosterone if his sex assigned at birth was male.
Even if there are different medical purposes, in some instances, there are often the same medical purposes, which is to prompt male puberty.
You look skeptical!
Douthat: Well, I don’t want to go too far down the rabbit hole, but it is a treatment for a different condition?
Strangio: But what makes the prohibition operative is whether the treatment is inconsistent with a person’s sex or consistent with a person’s sex.
If two people named John go to the doctor’s office and they say, “I am a boy and I’m not developing puberty in accordance with my peers, I need testosterone.”
Douthat: If you go in and say, “I’m developing my puberty to reflect a sex that I do not believe myself to be” — you don’t get it.
But those seem like different things.
Strangio: Well, the court thought that if you change the sex, you change the condition. And that was dispositive. Our view was that if you hold constant the purpose, then you change the sex and the outcome is different.
Douthat: Let’s save the rabbit holes for a moment. Just as a legal matter or a political matter — why do you think this kind of argument persuaded two conservative justices in the first case and not in the second?
Strangio: I think there are several reasons. I think the first reason, just in terms of the legal paradigms, the first case was a statutory case. This was a constitutional case. The interpretive frameworks for the Constitution are different. Usually, the court recognizes that something that is sex discrimination under Title VII would be sex discrimination under the Constitution.
And in this context, the court disagreed with our analysis of the logic of why it was, but for an individual sex, and they agreed with us in the Title VII context.
I do think, as often happens, some of the atmospherics and some of the anxieties that animated this litigation, that animates these conversations, made their way into the framework.
Douthat: I wanted to ask you about. Do you feel generally the political context of these decisions changed? In the first case, in Bostock, you are talking about issues related to transgender adults. And in the second case, you’re talking about issues related to minors.
It seems, to me, that a lot of the shift in the politics of this issue over the last four or five years is connected to that shift and how Americans feel about adult decision-making versus children and teenage decision-making?
Strangio: I want to disentangle the political from the legal. Obviously, they are connected. And as a doctrinal matter, the fact that it would be a minor versus an adult wouldn’t change whether it was based on sex.
That was one of the things that we raised for the court: By this logic, if Tennessee’s law had banned this care for adults, that would also be OK. So, that was something that, analytically, was important.
Yes, these are minors and we want to be able to have conversations about how to best protect and care for minors. But there are two important things that are true in this context. One, it was their parents who were making decisions. And we as parents have to weigh all sorts of questions when we’re making medical decisions for our minor children — which we do, of course, in conversation with them and their doctors. Then the second thing that is important that was lost here is that these categorical bans did not leave room for conversation. They did not leave room for more research.
Douthat: Last question on this legal environment, because you mentioned already that the decision to go to the court with this case, knowing you might well lose, was a difficult one.
After the ruling was handed down, there was a lot of argument and discussion, including an essay by one of my colleagues, Nicholas Confessore, about whether this had been a huge mistake for the transgender rights movement. You yourself were criticized by a number of people for these decisions.
I’m just curious if you can say a little more about whether in hindsight, knowing what you know now, would you have made the same decision to take this case all the way to the court?
Strangio: I guess the first thing I want to say is it certainly wasn’t my decision alone. I think it’s really important because these are our clients and there are many people who are involved in assessing what we do in any given moment. I simply can’t wield the power to make such a decision as this.
At the same time, I will say that in November 2023, when we made the decision to collectively go to the Supreme Court with this, I think that there were more people who were with us at that time. By the time it got to the court, I do think things had changed in the public.
But when we were litigating these cases in the lower courts in 2022 and 2023, seven District Court judges — including three appointed by President Trump — had struck down these laws. That was the context.
Then when that shifted and these bans started to go into effect, families that had never left Arkansas or Alabama or Tennessee uprooted their entire lives to care for their children, to try to find medical care. That felt like a dire set of conditions.
I think it was the right decision then, because the reality, as well, was there was already a circuit split. It was going to the court and even more so, questions about sports and questions about bathrooms were also about to get to the court. So, it was a hard calculus and a chess board of harm and moving pieces.
I don’t think in any of these contexts there are easy decisions. I wish that we had more tools now to fight back against the kind of attacks that we’re seeing from the Trump administration that were very much blunted by the Skrmetti decision.
I also think it was important to fight back from the lower court decision, which importantly was much broader than the Supreme Court’s decision, because the Sixth Circuit decision that we appealed from had also cut off a lot of avenues of advocacy that the Supreme Court did not.
Douthat: Give me an example.
Strangio: One example is that the Sixth Circuit had said discrimination against trans people by the government does not warrant any special scrutiny, that you can just defer to the legislature in those contexts. And the Supreme Court said, we’re not going to reach that question.
And the lower court also said that Bostock, the Title VII case, only applies to Title VII. The Supreme Court said, we’re not answering that question about the scope of Bostock’s logic.
Douthat: What would a larger scope mean?
Strangio: We’re going to be at the Supreme Court again, so they may answer some of these questions. So, a larger scope would mean that if a trans kid is kicked out of school for being trans, there is no constitutional claim, potentially, and no Title IX claim.
Douthat: So, Bostock applies to employers. So, the open question is issues of the military, housing, education.
Strangio: Exactly. Those are still in play.
Douthat: OK. That’s useful. We’ve talked a couple times about the idea of a changing political climate, but I want to just pause for a minute and talk about definitions. For listeners who may not have deep experience with some of these debates, just a basic question: From your perspective, what does it mean to be transgender?
Strangio: A transgender person is someone with a gender identity — so, their core understanding of their gender — that differs from the sex that they were designated at birth.
Douthat: OK. What does it mean to have a male or female sex assigned at birth, as distinct from being male or female in biological terms? What does that distinction mean?
Strangio: To me, what that distinction means is at birth, when our children are born, by and large, a doctor looks at their genitals and says, “You have a penis. We’re going to put M. You have a vagina, we’re going to put F.”
The external genitalia are one facet of the biological components of sex. There are others — chromosomes, hormones, secondary sex characteristics, and I would include within my understanding of sex, how we see ourselves. So, these are different aspects of our biological sex.
And then what differs from the sex we are given based on our genitals at birth and whether we are a boy or a girl, or a man or a woman, is that most of the time we see ourselves exactly as the genital check confirmed. Most people do.
Then there’s some of us who don’t. There’s something just fundamental and deep about the fact that that wasn’t the right way of seeing us. So, I would say that a man or a woman is someone who understands in their core that they are a man or a woman.
Douthat: Is there a distinction between gender identity and biological sex? Or is this just a continuum?
Strangio: I would say there’s a distinction. The way I understand it, our gender identity is in our bodies, it’s in our minds, it has a biological component. I think research suggests that there may be some fetal hormonal exposures that make it a biological phenomenon. But I’m not saying it is biological sex, as such.
I do think that oftentimes, the most salient biological components of our sex diverge from our gender identity, and those things are the disconnect that makes someone trans.
Douthat: But when they do, you wouldn’t say a person who the doctor looks at, says they have a vagina and that they’re a girl — you wouldn’t say that person is biologically female, but has a male gender identity. You would say they are just male, full out.
And there may be some tension between that and certain elements of their biology. But, there’s no split.
Strangio: I actually am fine saying that —
Douthat: I’m honestly not trying to entrap you in something. I’m very interested in understanding the kind of categorization —
Strangio: No, no. I don’t feel entrapped —
Douthat: Because I think understanding the categorization is relevant to, first of all, legal arguments.
Let me put it to you this way: A core claim of the transgender rights movement is that transgender identity deserves legal and constitutional protection. It deserves legal protection in the same way that one’s sex does, and one’s race does. It deserves constitutional protection the same way that one’s religion does.
But these are all different kinds of things.
Race and sex are seen as more about biology, ancestry, and so on than religion is. I want to understand where you think transgender identity or gender identity, however you want to phrase it, fits into that landscape.
Strangio: I think it’s important to separate what we’re talking about as a matter of law and what we’re talking about as a matter of medicine, because I do think that legal prohibitions on sex discrimination include transgender people. Full stop.
What we have seen in the last 10 years is the emergence of a legal notion of biological sex that has come into the law that was new. The displacement of sex as a legal category with biological sex as a legal category is a new phenomenon.
It comes in 2016 at the beginning of conversations about whether trans people should be able to use the bathroom that matches with our identity. So, there’s the question of how do we understand sex in the law and where do transgender people fit in with that? Then there’s a medical, scientific question —
Douthat: Sorry, can I pause? Before 2016, how did people think about sex as a category that was distinct from biological differences between men and women? What do you mean by that change in 2016?
Strangio: What we thought of as sex as a category — and this is in the context of civil rights and constitutional law — that it is just impermissible to discriminate against someone because of their actual, their perceived sex or their sex stereotypes. So, it didn’t necessitate defining sex.
The Constitution and our civil rights statutes also don’t define race. You can be discriminated against based on your actual or perceived race. You could be discriminated against because of your actual perceived sex.
In that sense, if we’re talking about the paradigm that prohibits discrimination, it didn’t necessitate defining sex. So, we start to see this impulse to define sex for purposes of sorting and excluding trans people that comes in 2016.
In that context, I think that the definitions we see in the statutes that emerge then say biological sex changes.
In 2016, it says biological sex is what’s on your birth certificate. Then I think we start to see definitions that are more about genitals. Then we start to see definitions that are more about chromosomes and reproductive anatomy.
That changes over time over the last 10 years. So, that’s the law and that’s obviously where I’m most focused on how these terms take on meaning.
Douthat: So, earlier we were talking about gender dysphoria as a medical psychological term for the experience of feeling like you are in the wrong body. Does that imply then that transgenderism should be perceived primarily as a medical, psychological condition in search of treatment?
Strangio: I think that transgender people should be understood based on the definition of having a gender identity that’s different from sex at birth.
I think that there are, for many transgender people — particularly when you cannot live in accordance with that gender identity — a medical and psychological set of needs that emerge to bring your outward expression into alignment with who you know yourself to be.
Douthat: But presumably, if tomorrow the state of Tennessee presented medical and scientific evidence — this is just a hypothetical — but presented medical or scientific evidence that there is a treatment, an alternative treatment, for the experience of gender dysphoria that reconciled the person’s psychology to their natal sex, the sex on their birth certificate, their genitalia, whatever else.
Well, I’m curious what you would say. But I’m very skeptical that you or any other transgender activist group would say, “OK, that’s great. We’re going to prescribe this treatment to teenagers expressing gender dysphoria.”
You would say, “Well, that treatment works by suppressing who they actually are.”
Strangio: The treatment is aimed at the distress. I would say, for me, that if there was a treatment tomorrow that you could take this medication and you could change your gender identity — I guess it depends on the premise.
If it could change how I understood myself, then it would be a question of “Do I like being a transgender person and having this discordance, or do I want to go and have a different experience?”
The premise suggests that you could change that gender identity and then you’d make a decision about how it is you want to live in the world without distress. I wouldn’t say nobody should have access to that if the premise is that you can make a decision about how to live most safely and comfortably in your body.
Right now, what we know is that forcing people to live in a way that doesn’t align with their gender identity does cause significant distress. And one set of medical interventions that has shown to significantly reduce those symptoms of distress, anxiety, depression and suicidality are these hormone interventions that Tennessee has banned.
Getting back to the question of sort of what is the nature of transgender identity —
Douthat: I feel like one reason that this issue is so fraught is that it’s very hard to escape that question. We’re both moving back and forth between language that seems appropriate to something that would be characterized as a psychological disturbance in search of a cure and language that would be appropriate to the description of a persecuted religious minority or women or men discriminated against unjustly.
I think you want to reconcile that tension by saying that there are these symptoms of distress and there is this medical treatment for those symptoms that works by effectively confirming biologically the psychological experience. Right?
Strangio: Well, I wouldn’t say it’s confirming because that suggests it has a role in reinforcing what the experience of one’s gender is. I think it is more aligning one’s outward appearance with their understanding of themself.
Douthat: But it’s more than appearance, surely. Your hormonal experience, your biochemical experience, I think we can both agree is very hard to separate from your psychological experience.
I don’t want to be too personal here, but can you talk about your own experience a little bit?
Strangio: Yeah, maybe that’ll help make it more concrete. Then I also do think it’s important to talk about how we’re conceptualizing it in the law and medicine.
But, my experience is that I had no idea what it meant to be transgender growing up. My first encounter with a transgender person was “Boys Don’t Cry,” the film about Brandon Teena, who was murdered. It was Hilary Swank playing Brandon Teena.
Douthat: How old were you?
Strangio: Gosh. I was born in 1982, so this is around 17.
My experience growing up is one of self-alienation from my body, but I did not have words for it. I didn’t have language for it. In my recollection of my childhood, I do not recall ever thinking, “Oh, I am not a girl.”
I just knew I was unhappy. I was in therapy. I did all of the things that you’re supposed to do, and had parents who loved me and tried to support me.
I continued to have this sense of distress and began to look for more help as a young adult. I went to therapy, talked to people, and what ended up happening is I was diagnosed with gender dysphoria. I had a therapist who helped me work through those —
Douthat: You’re in your 20s?
Strangio: I’m in my early 20s.
I graduated from college. I work at a law firm. I am trying to pursue my life, but I’m being held back by the sense that I can’t look in the mirror, I don’t want to shower, I don’t want to go outside.
Throughout this time, I should say, there’s no real access to the internet. There’s no social media.
So, I live like just a gender nonconforming teenager and young adult, who then comes out as gay. Still, I just felt this sense — not that I’m uncomfortable with my body as such, but that my body is the wrong body for me. But I don’t have the language for it.
Ultimately, what ends up happening is I have a realization through lots of therapy that there is something called transgender that fits my experience and that I start to then think about how to align my body with my sense of myself as male.
My experience is not representative of a lot of people because, as maybe is noticeable, I don’t express myself in a very masculine fashion. I try in little ways, but I recognize that I’m going to have an androgynous appearance. That is part of how I see myself.
But I did spend time in my early 20s, having access to surgery, taking hormones and starting to feel like everything in my life that I had tried to hide away, that I had tried to get rid of, made sense.
I was able to go to law school. I was able to become a lawyer that went into court — things that seemed absolutely unimaginable to me before.
Recently, when my mother was selling the house that I grew up in, and I went back and was packing things up, I found some old journals. And every single one of those journals had painful memories, I just kept saying, “I don’t understand why I’m not a girl. I don’t understand why I’m not a girl.”
I can’t explain it in words, these visceral core feelings — just like many things that people don’t understand until they feel them — inherent to who we are.
I talk to members of my family who have ADHD, who are trying to explain to me what it’s like to be in their brain. And I cannot imagine it. The best I can do is recognize that I don’t understand it and also try to support them in how they navigate the world.
So, that’s a little bit how I think about it — or any other aspect of our lives that we can’t articulate so well, but feels so core to who we are. When we look back, there’s all this evidence of where it was in things that we didn’t have language for.
Douthat: Can you just say something on the point about medical interventions? How did you feel the connection between that sense of psychological change and acceptance and making hormonal and biological changes to your body?
Strangio: Again, I’m saying this from my experience. Everyone’s is different. The best I can say is it felt like coming home. It felt like resolving a longstanding period of homesickness and then finally getting into your own bed.
And that enabled me to feel like there was a place for me in the world that I didn’t feel before.
I had a very vibrant, full life, but I could not occupy my body. So, that experience then allows me to go to law school, have a family, become a father, do all of these things that I think I always wanted.
But if you’re alienated from yourself, it’s a lot harder. I’ve seen that story with many people in my life, and then I’ve heard it from my clients about their kids.
I understand why people feel nervous when it comes to kids. I have a kid, I get very anxious about bringing my kid to the doctor and not understanding what information I’m getting back. I also think that we as parents do a lot of work to help our children grow and thrive — and I think my clients, who made these decisions for their children, also did that.
Douthat: Let’s talk about that difference for a minute. The acceptance of narratives like the one you just told has been, in some ways, at least partially accepted in American life. The language has changed — people would say sex-change operation, not gender affirming care and so on — but the idea of some form of male to female or of female to male transition in adulthood as a form of psychological reconciliation goes back decades in American life.
Certainly, by the time you get to the late 2010s, 2020, I think there’s just a widespread acceptance in American life that this is a free country. People have these personal experiences, they make these choices. You might be skeptical of those choices, but they are things that we make space for in American life.
From my perspective, what changes in a big way, starting in the late 2010s and then continuing into the present, is that the argument from activists becomes that these kinds of treatments and experiences should be available not just to 20-somethings and 30-somethings and 50-somethings — but to children and teenagers, minors. And over that same period, you get an absolute explosion in transgender, nonbinary, gender nonconforming self-identification among kids.
Then offering treatments that are, let’s say, debatable in their reversibility and that have pretty profound effects on your literal body, fertility — that just introduces incredible levels of danger of making the wrong decision.
Strangio: I know that that is the view of many people. Let me offer a little bit of a different perspective on how this emerges and some of the things that you’re pointing to, because I would not say that the beginnings of using these medications to treat adolescents comes from activists.
I think what we see is that endocrinologists who are treating adults are starting to see young people coming into their clinics and trying to figure out — as often happens with medicine when you have a treatment that works for an adult — if you can start to use it in an adolescent population.
It emerges through the medical community, trying to provide treatment for young people that are coming into their offices suffering. This happened in Europe first, and then in the United States in the late ’90s and early ’00s. So, it’s not that you have this all of a sudden happen in 2010.
Many of those clinics start to see very significant improvements in the populations that they’re working with, and they continue to want to study them. We start to see the rise of gender clinics in the United States that are treating young people —
Douthat: In a, it should be said, fairly deregulated medical atmosphere relative to Europe — the U.S., generally.
Strangio: Yes, there are a lot of differences between the U.S. and Europe. Absolutely. One of the ways that medical care in the U.S. is much worse than in many parts of Europe, is that we don’t have good access to mental health care. I submit that’s a very serious problem across the board, especially in rural communities and poor communities.
These gender clinics are trying to account for that. They’re trying to — rather than have people go into more underground spaces, more dangerous spaces — combine these multidisciplinary teams that are aimed at treating young people in a way that is supporting their mental health, that is understanding any co-occurring conditions and ensuring that their parents understand all of the risks and benefits of any potential intervention.
That is my experience in learning about these clinics, which I did not really interface with until care started to be shut down in 2021. But studying them, I see them as very highly sophisticated, well-funded research clinics at institutions like Boston Children’s Hospital and U.C.L.A.
So, you have that model that is emerging. I agree that it is a model that you did not have a lot of, and now we have a lot more of in the United States and they’re meeting patients’ needs. I don’t see the causal connection being, “We’re providing this care so there are more trans kids.”
Douthat: I wouldn’t say it’s necessarily a connection of the clinics themselves providing the care. I think that there is a broader cultural shift that would take a different argument or conversation to unpack.
But that there is a certain kind of social cascade that, honestly, follows from debates about same-sex marriage, where gender identity, questioning your gender identity, thinking about your gender identity as a distinctive thing in the context of adolescence and puberty just becomes a broad cultural phenomenon.
Then it’s the combination of that cultural shift intersecting with the existence of these clinics and these, again, very concrete medical interventions that creates a lot of anxiety.
Obviously, you’ve represented parents who are deeply committed to the idea that they’re doing the absolute best thing for their gender nonconforming or dysphoric child.
I have known parents — liberal parents, progressive parents in the context of the last five or six years — who have a child who is gender nonconforming or self-identifies as trans over some period of time, who are also trying to do the best thing for their kid, but are living in a state of deep fear and anxiety that if they say the wrong thing, this child will be persuaded by the cultural atmosphere to do something to undertake a set of medical interventions that are potentially irreversible and have lifelong consequences.
I’m curious what you think about those kinds of fears.
Strangio: A few important points.
One is that a very small percentage of people who are transgender ever go to a gender clinic, and the number of people who then have access to treatment is even much smaller. So, we have a significant amount of gatekeeping here, at many levels.
Some people don’t recognize that they have dysphoria. They may identify as transgender, and never go to the clinic. Then within that, the actual number of people who then are diagnosed with gender dysphoria and then assessed to have a need for medical intervention gets smaller and smaller.
I also want to be clear that many of these young people are not experiencing dysphoria for the first time at puberty. There are many young people who have a consistent and persistent presentation and insistence of themselves as girls who are assigned male at birth from very young ages — including in families where the parents have no idea what it means to be transgender. They are learning about it over time, after many years of confusion about what is going on with their child.
I will say, as a parent, I understand having all sorts of fears about what my kid is going to see on social media, what is going to happen at school. I think we’re primed to have a lot of anxiety about our children, and I personally feel that a lot of the anxiety I have about my child is very reasonable.
I also don’t think that there is an incentive for people to become trans in the world. This idea that if the parent says the wrong thing, the child will then go become transgender is not something I’ve seen borne out.
Douthat: I think that’s a slight oversimplification of what I mean.
It’s more parents who have children who are already identifying as transgender. The parent has strong doubts about the permanence and durability of that identification, but is afraid that if they resist it too strongly, they will get a reaction from the child that pushes them further toward the funnel of medical and surgical interventions.
That’s what I mean.
Strangio: I understand. What I want is space for parents and children and doctors to have these conversations — not for that child to express a transgender identity and then go get hormones the next day. Not at all.
But I do think it’s really damaging when you have the government coming in and saying, “We’re cutting off this intervention. We’re not studying it. We’re not putting in safeguards.”
West Virginia took a very different approach at first. We had a law in West Virginia that said we’re going to provide more oversight. That’s one of the ways that we, as legislators, regulate medicine, is to identify a problem: over-prescription of opioids, lack of informed consent for gastric bypass — all of this for minors, as well.
They said, we’re not going to ban those procedures, but we are going to require stringent informed consent requirements — additional doctor’s notes, assessments. West Virginia said, you need two independent assessments as a minor before you can have access to these medications and then put in place a very particular informed consent requirement. Nobody challenged that law. People followed that law.
Douthat: Do you think that law addressed a real problem with clinics moving too quickly? Do you think there were clinics that moved too quickly from diagnosis to prescription?
Strangio: I don’t necessarily think that the existing safeguards that we have for medical malpractice and other oversights weren’t enough. But, as in all of medicine, there are probably examples where things were prescribed without the oversight needed, that things were moving too fast in some places.
I will say I’ve seen that in aspects of my child’s medical care outside this context. We can assess that there are differing views about how serious it is here as opposed to other contexts, but I certainly don’t think that gender-affirming care was immune from the problems with medicine in this country.
If a legislature had concerns and documented evidence of that, I think that is an appropriate solution to that set of concerns — not saying, “We’re going to ban the care, we’re going to cut off your treatment.” I think that’s really, really different than what legislatures usually do when they have a concern about over-prescription, lack of assessments. There are other mechanisms that the law has short of a categorical ban.
Douthat: But I think you have to see some of these legislative responses … One, they’re in a certain kind of continuity with shifts in Western Europe, which is not particularly religious or Republican territory. But you have a number of European countries that have taken steps to impose much stricter regulations on the use of some of these practices and protocols.
But then the other background here — and you know, American politics is always operating in this space of sort of backlash, overreach, backlash, overreach — but the narrative that I heard from transgender activists in 2019 to 2023 was often not just that there is some discreet number of children who need this kind of care and we want to make sure they get it. The narrative was often people who say that most children who express some kind of gender dysphoria, ultimately desist and become reconciled to their natal sex — that’s transphobia.
That was a pretty clear line of argument that was used in specific cases to attack specific practices and doctors who were themselves arguing that lots of teenagers who experience dysphoria are better off with some kind of treatment that tries to reconcile them rather than a treatment that interrupts puberty.
Would you agree that that argument existed and still has real potency?
Strangio: For myself, I am very hesitant to announce things as transphobic without having an opportunity to try to have conversations. And that’s where I am right now.
Douthat: You’re here right now.
Strangio: That’s why I’m here with you. I want to understand where people’s anxieties are. I want to find places where we might agree.
I do think that there’s a lot of confusion about some of the science related to gender non-conforming young kids and what happens at puberty. I agree that there are a lot of young people who express gender non-conforming expressions and behaviors who are not trans and who will never be trans.
I’m not a doctor…
Douthat: That’s OK, neither am I. I have some strong medical opinions notwithstanding.
Strangio: As do I, but I am trying to limit my expertise to where it’s warranted.
I do trust child and adolescent psychiatrists to assess based on existing diagnostic criteria. So — a child who is persistently and consistently, for years, saying they are a girl versus a child who paints their nails and wears dresses and in other ways is gender non-conforming, assuming both these children are assigned male at birth, I think there is a difference.
I think that child and adolescent psychiatrists assess these differences, talk to the parents. Then the question is, after the onset of puberty, is there a distress that is prompted for those children with those consistent and persistent identifications that are different from their sex assigned at birth?
I do not want a parent to feel like they can’t have a conversation with members of their community or trans adults or doctors without being afraid of being called transphobic. That is something I feel really strongly about. Maybe I’ve grown in this area, especially as a parent — the last thing I want is for people to feel like they can’t ask questions.
So, at least in my life, I am very committed to the asking of questions, the safe spaces for asking questions. Maybe it doesn’t have to just be to you. Maybe some of us can open our ways of engaging.
And, at the same time, when I think about the law, which is what I am focused on every day in my life, for a lot of these questions, there are just basic legal principles that I still think should apply. I still think that we should have a check on the government’s intrusion into our family decision-making. I still think that the Equal Protection Clause should apply to everyone.
I’m not someone who is out there making policy. I’m someone who’s looking at the laws that are being proposed and the laws that do exist and assessing whether or not they are violating our Constitution and civil rights statutes.
Douthat: All right. I have to ask you about the specific case of sports, then we can go back to the bigger picture to finish up. Sports are a slightly different case, where it’s not so much parents worrying about a social contagion effect around gender identity. It’s parents worrying about basic unfairness in competition.
It again, comes back a bit to these initial philosophical questions that we were trying to wrestle with — about the nature of sex and biological sex and so on. But in the United States, we have, in high schools and in colleges, sports that are sex segregated. Is that a good idea?
Strangio: Yes, I am in favor of sex separated sports in most circumstances. And part of the reason is — I’m going to land the plane, but I want to bring us on a little detour, which is that I’ve been doing a lot of research about the origins of Title IX.
Title IX is the civil rights statute that bans sex discrimination in education and is largely associated with sports. Although, when it was first passed by Congress in 1972, there was a real set of questions about whether it would apply to sports at all. Congress passes another law a few years later that tells the agency at the time, you have to come up with regulations about sports. And there’s a huge uproar in the men’s sports community because the idea of sharing resources with women is intolerable.
So, there ends up being a lot of effort put into, in critically important ways, the investment in women’s sports. And I think that the context of sports in which we continue to have sex separation is an important part of continuing that promise of Title IX.
Now, do I think that we need to have sex separated sports because of some concern about women not being able to have access to sports teams if they’re not sex separated for the reasons that you identify? Yes. I accept the premise that, in the aggregate, men have athletic advantages in a majority — though not all — sports and that one of the ways that sex separation has worked is to ensure those opportunities for women.
However, I do not think that’s the only reason. I also don’t think that’s the relevant question when we talk about trans inclusion in sports. But, I do accept that sex separated sports is an important part of preserving women’s opportunity in sports right now.
Douthat: I will tell you a story, which is that a school in my general vicinity, during the peak of what we call wokeness nowadays, had a field day that had traditionally had separate sports for men and women, and they decided they needed to put the girls and boys together.
And the reports from the girls the next day was that they were absolutely miserable because, of course, the boys won — I don’t want to say all — but won most of the games.
So, what is wrong based on that reality with saying that whatever the absolute truth about the nature of transgender identity is, if you have the advantages of a biological male, you should compete in male sports? What’s wrong with that?
Strangio: There are two things that I think are wrong with it when we’re talking about categorical exclusions. I am not disputing that there are conversations to be had about how we manage the inclusion of trans people in sports.
But, if you have a rule — as half the states in the country do — that from kindergarten through college, or sometimes sixth grade through college, no trans girl can ever compete on a girl’s team. I think that that poses a problem for two reasons.
One, I think that complete exclusion from athletic opportunities that align with gender identity — even practices, even intramurals, even club teams — violates the promise of equality under Title IX and the Equal Protection Clause. Because if the question is about not participating if you have an athletic advantage, then why not in the noncompetitive spaces? That’s the first piece of it.
And then the second is, we do have a group of young people who have never gone through a male puberty. They transitioned before they did, they received puberty blockers. All of the evidence in those cases is that they do not have that athletic advantage because in the aggregate, the driver of athletic advantage is circulating testosterone. They have never had that. They’ve never gone through an endogenous puberty. And they too are categorically barred from all women’s teams.
So, I think in those two circumstances, I would say it highlights that the breadth is the problem.
Douthat: So, in the last case, I want to stipulate that I think that argument about the nature of the advantage is contested, but let’s say that it were true: Would then the solution be to have a system of basically like effectively strength testing or hormonal analysis or something? You’re objecting to categorical bans, but what is the case by case approach that you’re imagining?
Strangio: Well, it depends on the context. But if we’re talking about competitive high school athletics, my view is that it should be left to the athletic associations to come up with a rule that balances inclusion —
Douthat: That’s a cop out. You’re in charge of the athletic association. What’s your rule?
Strangio: Well, my rule is not a rule that you probably agree with.
Then I’ll give you a rule that I think would be the appropriate compromise. Because I’m in favor of talking about compromise.
So, my rule would be that you have to undergo hormone therapy for a period of time that is studied for the age group, and then at that point you can participate.
We don’t test individual athletic anything in order to participate on a team for boys and girls. I think that we come up with a rule, it’s applied. Once you meet the threshold, then you can participate. I think that balances equity, inclusion, and concerns about athletic advantage. That would be my proposal.
What I don’t understand is why when we propose things, that our compromises are met only with bans. Because another option would be to say if you, if you are on puberty blockers, if you went through only, uh, female hormonal puberty, um, and that you can you submit evidence to that effect, then what is the basis under the argument about athletic advantage of excluding that individual?
Because there were examples of associations that were starting to impose more stringent rules that looked like that, and then this administration forced those to go back to a categorical ban. So, I think there’s just questions about why are we categorically excluding people and why are we going so young in age?
Douthat: Let me make a suggestion then for why you have that resistance to compromise right now. In part, it’s rooted in a sense that your side is interested in compromise now that it is facing cultural setbacks. But just a few years ago, it was taking a much more maximalist position. And so it is a normal feature of cultural contest and democratic politics that if you overreach, then your protestations that you only want compromise might fall sometimes on deaf ears.
And again, in the case of women’s sports, I don’t know exactly what the ideal medical testing regime is that would enable certain transgender athletes to play — I’m open to an argument about that — but I just lived through a period where, regardless of what a medical test said, I could look at a photograph of someone like Lia Thomas, who was extremely successful as a female swimmer.
You could just look at the photographs of Lia Thomas with female teammates. And from my own point of view, it looked absurd. It looked like absurd overreach on the part of the transgender rights movement that was undermining the basic fairness of women’s sports.
That’s also my larger perspective here. You said earlier that maybe you’ve learned something about the importance of dialogue and safe spaces and compromise and so on. I feel like, if you have learned that it is as the result of overreaching.
Strangio: Just to respond to the example of Lia Thomas, one thing I’m worried about is that if we accept the premise that what we’re doing is looking at people and deciding who is trans, then we as bystanders are going to be policing the bodies of women athletes.
What’s happening now is that the people who are being pulled aside for “sex testing” are cisgender girls with short hair, with big muscles. Serena Williams spent a very significant part of her career being accused of being a man. Tall, fast women athletes are often accused of being men, and so we’re imposing this type of regime.
I’ve always been open to dialogue. I just think that right now there is this false narrative that we were never in a position to want to compromise, when my very first experience talking about women’s sports was in the context of the government proposing a ban on it. That conversation was introduced in order to try to undermine the ability for L.G.B.T. advocates to move basic nondiscrimination protection.
We didn’t introduce a conversation about sports or about restrooms, and I think that that’s an important part of this history. Following Obergefell, following the Supreme Court’s decision striking down bans on marriage equality and the efforts in Charlotte, N.C., and Houston, Texas, to pass nondiscrimination ordinances, which people continue to say are largely popular — that’s where we started to hear about trans people using the bathroom. And then subsequent to that, about trans people in sports. We did not introduce those.
Douthat: As activists, you’re saying you didn’t introduce those debates?
Strangio: Right. We weren’t asking for inclusion in those spaces.
We were asking to not be fired from our jobs, to not be kicked out of hotels, and that was the step that started in 2016 and was met with a campaign about predators and bathrooms.
Douthat: I want to ask then about coexistence, because to me, part of the framing of this debate from your side in the last few years has been a narrative of threat — not only the kind of policy steps that the state of Tennessee has undertaken, or that the Trump administration has undertaken, but just a straightforward claim that I, as a parent of girls, would not want them to compete against someone like Lia Thomas.
Those arguments are often met, in my experience, by a claim that just the arguments themselves did a kind of profound psychological harm to trans youth, to kids dealing with extremely difficult physical, psychological, political circumstances. That essentially, interventions for trans youth were essential to prevent suicide.
But it wasn’t just about suicide, it was a general narrative. I felt that to be skeptical of the claims of the movement, there was a sense that it was an act of almost violence against transgender people.
We’ve had an extended conversation here. We’re trying to land the plane. But I’m just curious, do you feel threatened by skepticism and critique in this area?
This is the last thing I’ll say and then you can answer.
If I say to you that I believe this is a free country and I think that people who have deep and profound dysphoric experiences of their own body should be free to identify as the opposite sex as adults, but I also think that a lot of the interventions offered to trans identifying teenagers are going to be remembered as dangerous pseudoscience that did damage; if that is my position — that is my position — do you feel like that position can coexist with basic American liberties for transgender Americans? Or do you need to win? Do you need to have my position ruled out of bounds to feel like you’ve made America safe for trans identifying youth?
Strangio: Well, I certainly don’t think your position should be ruled out of bounds. I don’t want you to not have the position that you have that’s core to what you see and experience in the world.
Douthat: Well, no, but you’d like to talk me out of it, at least.
Strangio: Of course I would, but what does it mean to be out of bounds?
I would like to persuade you. I’m here, I’m an adult. My job is to talk to people who disagree with me. So, I don’t feel profoundly threatened by it.
I think it’s a matter of scale too, because when you have hundreds of millions of dollars going into telling a story to the American people that 1 percent of the population is a threat, that does have an impact that does make people feel unwelcome in the American promise. To feel that every time there’s an election, the entirety of political ad spending will be spent on saying that we are a threat, that we need to not be part of the fabric of society — that is how it’s interpreted for a lot of people, and I understand that because we don’t have the capital to respond in any meaningful way to that type of ad spending.
Part of what I experience that people say is upsetting and dangerous at times, and alienating to young people is the magnitude. I think a lot of us wish we could just be ignored, and that the amount of resources that have gone into putting a spotlight on us is something that I think is greatly disproportionate and very harmful.
So, that’s one thing. And then as to what you asked about your position and it being out of bounds, I do think that banning health care for minors when it’s recommended by their doctors and consented to by their parents and preventing us from getting more scientific information about it, I think that violates the Constitution.
And I do think it’s harmful.
Douthat: But that is premised on a very specific argument about what you think medical evidence shows. Because you would agree that states have the right to ban medical procedures that turn out not to work as advertised.
Strangio: I agree that my view of the evidence, the clinical evidence and the research evidence, is that these are safe and effective, and that the proposals to provide only therapeutic interventions or do nothing are not supported by evidence at all. That is my position.
I would also say that it sounds like most of the time where we are is that people are debating the quality of the evidence. I don’t think it is very common for the government to ban a medical treatment when it is being debated. And I think a lot of these states have the right to try laws that are not limited even to context when someone is terminally ill, that allow individuals and parents to try interventions that they want.
There is a long history of that. There’s a history in these Southern states — of allowing people to take ivermectin to treat Covid just after it was proven not to be effective. So, I think when we’re talking about disagreement about the science, I think it is very unusual for the government to come in and impose a blanket ban.
Douthat: But it’s just very hard to escape the philosophical question. I have a lot of personal experience with wanting to use medications that not every doctor would prescribe. I had a chronic medical condition that was not widely scientifically recognized.
And I wrote a book about that subject and had a couple people write me notes saying, did this change how you think about the trans issue?
And I guess it depends on what you think in the end, the reality of the final category is right. Like, is there a real category of people who are fundamentally born in the wrong body? I know that’s not the politically favorable way of describing it — in which case, you are treating them by changing the physical reality of their body.
But if it is just a severe, sincere, profound psychological condition that doesn’t have this kind of almost metaphysical reality, that’s why people react to it like you’re telling teenagers to essentially go to war with their own bodies.
I feel like it’s hard to get around that debate of what is health? What is health for a transgender person?
Strangio: For me, it feels profound.
It feels metaphysically, holistically, physiologically, biologically who I am — that there was no choice to be made. And that is how most of the people that I know talk about it and experience it. It also means that I can’t always put it into words that are going to make sense to another person.
I believe that health for the transgender community is continuing to make space for us to learn about how to best interact with and treat our bodies. Right now, what I think we’re seeing is the cutting off of a lot of information, and I do appreciate you saying that you think as an adult, that I can make that decision.
I think there are many people who are starting to encroach on the ability of adults to make these decisions, even as all sorts of things are widely available to adults in the United States — and that, to me, signals how much there is a desire to stamp out aspects of who we are in a broad way.
Douthat: All right, Chase Strangio, thank you so much for joining me.
Strangio: Thanks, Ross. Thanks for having me.
Thoughts? Email us at [email protected].
This episode of “Interesting Times” was produced by Victoria Chamberlin, Raina Raskin, Andrea Betanzos and Sophia Alvarez Boyd. Associate produced by Emma Kehlbeck. It was edited by Jordana Hochman. Mixing and engineering by Sophia Lanman, Pat McCusker, Kyle Grandillo and Efim Shapiro. Cinematography by Marina King. Video editing by Julian Hackney and Steph Khoury. Original music by Isaac Jones, Sonia Herrero, Pat McCusker and Aman Sahota. Fact-checking by Kate Sinclair, Michelle Harris and Mary Marge Locker. Audience strategy by Shannon Busta. Video directed by Jonah M. Kessel. The director of Opinion Audio is Annie-Rose Strasser.
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