Piece one, August 13–14

Wolves in White Coats: How Doctors and Hospitals Pushed and Profited from the Fraud of “Gender Medicine.”

HHS commissioned it. Advocacy staff wrote it — people from Independent Women’s Forum, the Center for Christian Virtue’s president, a former Trump White House lawyer now running Independent Women’s Law Center, and a couple of physicians well known in this fight, including the surgeon who anonymously leaked patient records from Texas Children’s Hospital in 2023. Several contributing organizations are ones the Southern Poverty Law Center classifies as anti-LGBTQ hate groups.

Its argument: pediatric gender clinics turned trans kids into “captive patients,” and clinics coded insurance claims fraudulently — billing puberty blockers under a vague “endocrine disorder, unspecified” code instead of the gender dysphoria code, so insurers who wouldn’t otherwise cover the treatment would pay. They cite a whistleblower nurse’s testimony, a $10 million False Claims settlement Texas Children’s Hospital did pay, and a similar Cleveland Clinic settlement.

Real billing fraud should be investigated, of course. But the report doesn’t call for auditors — it calls an entire field “the fraud of ‘gender medicine’” in its own title. A physician quoted in one of the only real fact-checks I found said flatly that pediatric gender care is a strange place to try to defraud the healthcare system, because that population is “massively underserved,” not a lucrative racket — and that same piece cites Harvard research showing surgery on minors is genuinely rare. A handful of real settlements got laundered into an indictment of an entire field of medicine, by people who’ve built careers arguing that field shouldn’t exist at all.

Piece two, August 24

The White House “Back to School” event.

This is where the lying stops being implied and starts being said out loud, on the record.

Linda McMahon, Secretary of Education: “After the Biden administration allowed schools to secretly transition students without parents’ knowledge, President Trump is defending parental rights like never before.” The Advocate fact-checked the underlying cases the education department cited, and found that school staff had declined to share a student’s own pronoun use with parents without that student’s consent — a privacy practice, not a secret medical transition, because there is no medical transition happening in schools.

Trump, at the same podium: “Every public school in America is now on notice that if they tell a child that they’re trapped in the wrong body, they are committing child abuse.” “Trapped in the wrong body” is language that’s been part of mainstream discussion of gender dysphoria for decades. He just redefined it, on the spot, as a federal crime. (Coverage of both quotes here.)

And at a rally in Myrtle Beach the day before, he claimed: “Hospitals now are doing reverse surgery, at my order. They’re doing reverse surgery. Nobody ever heard about it.” Yeah, nobody “ever heard about it” because it isn’t happening. There is no order. And what surgeries are being reversed? The detransition clinics that exist came out of DOJ settlements, not a presidential directive, and because they were created through legal settlements and not patient demand, we have no idea if they have even one single patient.

To say it plainly: they lied, at a podium, about children, and called it defending them.

Piece three, around August 26

Where the Clinic Meets the Movement: Does Gender Ideology Arm Left-Wing Authoritarian Psychology?

This is a newly released “report” by HHS and it’s worth noticing where it isn’t as much as what it says. It’s not on the HHS website or listed in their press room. It was posted quietly on the less-visited sub-agency’s health.gov page quoting Admiral Brian Christine, Assistant Secretary for Health. And yet Daily Signal, Breitbart, Washington Examiner, and Blaze Media — the last one running the headline “Our results shocked us” — all had pieces up within a day, treating a non-representative online survey as settled science before anyone outside that circle had time to read it.

So where did this report come from? I’m glad you asked.

Researchers from the Manhattan Institute and the Network Contagion Research Institute invented a "Clinical Gender Affirmation Scale" (CGAS). To score this scale, they surveyed 1,208 people on a paid online panel and asked them to agree or disagree with five statements pulled straight from clinical guidance published by the American Psychological Association, the American Academy of Pediatrics, and WPATH:

1. “Failure to affirm a transgender person’s gender identity increases the risk of serious psychological distress to the trans person.”

2. “People should be supported in expressing their transgender identity.”

3. “Using the name a person chooses as part of their gender transition is a necessary form of support.”

4. “Using a transgender person’s preferred pronouns is a necessary form of support.”

5. “Parents should support their children’s transgender exploration.”

I’ve said versions of every one of those sentences in living rooms, in support groups, in legislative hearings, and yes — to educators — for fifteen years. According to this invented scale, agreeing with these statements predicts a psychological profile the authors call “left-wing authoritarianism,” a profile that correlates with justifying acts of political violence, including killing Charlie Kirk or killing the president. The authors admit that they "cannot adjudicate" whether gender-affirming beliefs cause authoritarian attitudes, or the reverse, or whether some third factor drives both, but they still leaned into it. The Human Rights Campaign called the report for what it is — “junk.” I stand with that assessment completely.

Piece four, August 27

The storybook video.

Secretary McMahon’s social media accounts posted an illustrated “Twas the Night Before Christmas” parody, captioned “A new chapter in American education begins.” It recaps a year of policy in (really bad) rhyme — literacy funding, civics class — then slides into: “And if woke personnel administer a sexually explicit survey, the minor child’s parents know they have the right to say ‘no way.’ Locker rooms will be separate the way they’re supposed to be. No male entering a female competition can steal a trophy.”

The words never say “trans” or “gay.” The pictures do the naming instead: a teacher under a Progress Pride flag and a trans flag, in a COVID mask, papers in hand, while two parents look on alarmed from the doorway. A drag queen swept out a school door with a broom while Trump gives a thumbs-up. A heavily muscled, bearded man in black wrestling gear standing on the number-one podium spot, a bald eagle delivering him the trophy, while a small blonde girl stands defeated in second place — nobody’s pretending he looks like a teenage girl on a team — he looks like a WWE villain, because that’s the image they wanted.

And then it closes on a family road-tripping in a car painted like the American flag, MAGA and MEGA flags snapping from a motorcycle escort by Trump and McMahon.

Name what that is: it’s grooming. Not the trans kid in gym class, not the parent holding her kid’s hand at a school board meeting — the federal government, wrapping cartoon villains and dog-whistle imagery in the flag, teaching children in rhyme who to fear and who to trust, on an official taxpayer-funded account.

Four pieces, two weeks

A “fraud” report to hand prosecutors and insurance regulators a document to point to; two officials lying at a podium about what schools and hospitals actually do; a quietly posted “violence” study to hand cable news and legislators cover for treating trans people, parents like me, and other allies as dangerous; and a cartoon to teach it all to children directly, set to nursery-rhyme meter and dressed in the flag. That’s a campaign, built on purpose, in that order, by people who spend the rest of their time accusing LGBTQ folks and allies of grooming children with an ideology.

I’ll be back with a closer look at that third report’s methodology soon. For now: know what these documents say, know who wrote them, and pay attention to the inflammatory, radical language. Know that the people running the country said things about trans kids that were 100% fabrications. And don’t let anyone present you with a fairy tale and call it policy.

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This one arrived Saturday:

“Old cunt Debbie can’t even get her fucked up son to appear on camera any more. A J will probably commit suicide. It will be entirely the fault of his asshole mother Debbie. A J’s pussy dad wouldn’t even stand up to his disgusting wife. The whole family ought to just commit group suicide.”

A few years ago, I gave a speech because I wanted to start conversations that would build a safer world for my children. I didn’t use my transgender child’s name, but later, Avery wanted to be visible. They believed — we believed — that a family willing to be seen could move hearts in a way that statistics couldn’t. And for a while, it worked, although some people decided we were public to chase fame or fortune. (Imagine a million laugh emojis here at that idea.)

Then people who wanted us erased gained real power, and visibility stopped being a strategy and started being a risk. We pulled back — not because we were ashamed, but because we were trying to keep our child alive.

As you can see from the message above, the same people who once accused me of exploiting my kid for attention now point to our quietness and Avery’s desire for privacy as proof of something else entirely — regret, backpedaling, a family finally seeing sense. They never ask what changed. They never wonder if they were the cause.

That’s the catch-22 of being a visible ally: you’re condemned for showing up, and condemned again for the ways you protect your child once showing up gets dangerous.

And that guy? He calls Avery “AJ.” That’s the name we used in 2014, when I gave my first public speech, and we used initials for their anonymity. He’s been at this for over a decade. He must have a calendar reminder, because I get a message at least once a month. He never asks how Avery is doing. He never has. What he does instead is jump straight to suicide. Group suicide, even.

So tell me again about protecting children.

Anti-trans legislation gets sold to the public one way: bathroom bills, sports bans, healthcare bans, book bans, always draped in the same borrowed urgency, always performing concern for kids the legislators have never met. Policies built on that performance do real damage — they close clinics, they push families like mine out of states or out of the country, they tell trans kids the adults in charge think they’d be better off not existing. That’s the actual child-protection record of the people writing these laws. And this is the extracurricular activity of at least one of their supporters: a family suicide note, sent like routine correspondence.

What kind of person does that and still tells himself he cares about kids?

He’s not alone, either. The next day, this one showed up on Instagram, on my post celebrating Avery’s birthday in June:

“One day, maybe in the distant future, you will realize how evil you are and the harm you did to Avery. Maybe it will be on your deathbed. But that point you will rightly wish that you’d never been born. And you did it all so people would pay attention to you. You are satanic.”

Different person. Different platform. Different vocabulary. But it is a pattern that keeps repeating itself among strangers who’ve never spoken to each other. That’s not a fringe obsession — that’s sociopathic behavior, and it’s been allowed to become a climate because people in power did this with purpose, while others looked the other way.

I should say clearly: most publicly visible families don’t get messages like these. Visibility can even work like a kind of shield. Visibility isn’t the variable. Brazenness is. I’m not the only parent getting these messages. I’m just one of the few willing to show you. Plenty of families who’ve never posted a single photo, who’ve done everything “right” by the rules these people claim to care about, get messages just as ugly — usually from someone local, someone known, someone with access precisely because the family stayed quiet and trusted their community.

Here’s what actual concern for a child looks like: it asks how he or she or they are doing. It wants him or her or them alive, healthy, housed, loved — regardless of what their gender looks like from the outside. It doesn’t require a child’s death to make a point.

What arrives in my inbox is the opposite of that, and it always has been. Not one message, in over a decade, has asked how Avery is. Not one has expressed a shred of interest in whether they’re safe, whether they’re happy, whether they’re thriving. In fact, many of them advocate for Avery to take their own life or [as one message said when Avery was only 6 years old] to “get cancer from a fake vagina and die a slow, painful death.”

Each message can be summed up as this: my child, my family would be better off gone. That is not child protection. That is not concern. That’s a mask, and I’m tired of watching people wear it into legislative hearings, school board meetings, and cable news segments while their actual sentiments toward children like mine come out, unfiltered, in my inbox once a month.

If you were horrified reading some of this — good. That’s the correct reaction. I’d worry about you if you weren’t.

I won’t pretend these messages don’t land somewhere. They do. A decade of them adds up, even for someone who’s already been called far worse by her own family. But here’s what gets me through it: these messages come to me, and not to Avery. That’s the job. That’s what a parent is for — to stand between your kid and whatever’s coming, and take the hit yourself so they don’t have to.

This is exactly why I got into this work in the first place. If absorbing messages like these means one more kid never gets targeted, or one more parent never has to open an email like this alone, I’ll take it — gladly, without regret.

So consider this the curtain pulled back. As we commonly say, “It’s not about bathrooms, just like it was never about water fountains.”

Hear me: it’s not about concern for children. It never was. It’s about hate, pure and simple — evil disguised as policy, a decade of transphobia dressed up as a legislative agenda that has let sociopathic behavior like this grow unchecked and unchallenged.

On July 13, the Dirección General de la Policía published a new protocol implementing that order. As of July 16, foreign nationals living in Spain can go to their local Brigada de Extranjería and request a corrected sex marker and name on the TIE (the foreigner’s residency card), the CRUE (EU citizen registration certificate), and several other identity documents Spain issues — even if their passport still says something else, as long as they can show it’s not possible to fix that passport back home. (Again…hello, American friends!)

If you’ve followed my family’s story, you know why I care about this specific bureaucratic crack in the wall. My nonbinary teen had an X gender marker on their U.S. passport, issued years ago, that we used when we first applied for our visas. Going through Spanish residency process, the TIE (identity card) was built directly off that passport, X marker included. It required a call to the HQ in Madrid to confirm, since X markers are not a thing here. While living here, they needed a new adult passport…and it happened right before the EO was released (more on that below) saying the State Department would only use sex-at-birth going forward. We had to scramble to request they stop processing the application and send back the youth passport, then scrambled to submit it again during the short window that the EO was blocked. Thankfully, we have a passport with an X that we will be able to use when we request that our visas are renewed. Unfortunately, most trans folks are stuck without that option anymore. US citizens aren’t the only ones with horrible, anti-trans people running their governments. Many other countries have similar policies, so you can see the problem this new protocol is trying to solve.

How Spain’s trans law was supposed to work — and where it stopped short

Spain’s Ley 4/2023, locally known as the Ley Trans, is genuinely one of the more best pieces of gender-recognition legislation in the world. A Spanish citizen over 16 can walk into a Registro Civil, declare their name and legal sex, and have it updated within about a month. No medical letter, no psychological evaluation, no surgery requirement, no judge. Fourteen- and fifteen-year-olds can do it with a parent’s consent; twelve- and thirteen-year-olds can do it with a judge’s approval. It is, on paper, self-determination in its purest administrative form.

Article 50 of the Ley Trans extended a version of this right to foreign residents — people who can show it’s legally or practically impossible to change their sex marker in their own country. But for two and a half years, Article 50 was a right on paper without a working process in reality. There was no defined process at Extranjería for using it. Your options were essentially to ask nicely or sue.

So someone did sue. The Sección de lo Contencioso-Administrativo of Madrid’s Tribunal de Instancia (No. 17) just ruled on June 5 that the administration had to act on a immigrant’s request to correct their documents, since Spain had already blown past the one-year deadline the law itself set for building this process. Interior Minister Fernando Grande-Marlaska admitted as much in the Senate a few weeks later, telling Más Madrid senator (out and proud trans woman!) Carla Antonelli plainly that “the current procedure isn’t working” for immigrants who can’t fix their paperwork at home. He promised an urgent fix. And now, only six weeks after that promise, we have one.

What the new protocol does

The Policía Nacional’s protocol splits into two tracks.

If you’ve already had your gender marker legally changed in your home country, it’s really simple: you show your current passport or travel document reflecting the change, along with the Spanish document you want corrected, and Extranjería updates it.

If you can’t get your home country to make that change — which describes every trans or nonbinary American applying for a new or renewed passport — the Brigada de Extranjería y Fronteras will request a report from Spain’s Ministry of Foreign Affairs confirming that the correction is legally or factually impossible where you’re from. If the report comes back confirming it, Spain will update its own Central Registry of Foreigners and issue you a corrected document.

Why this matters for Americans

To review, just after taking office in January 2025, The Orange One signed an executive order directing federal agencies to record “sex at conception” on identity documents. The State Department stopped letting trans, nonbinary, and intersex people update the sex marker on their passports and eliminated the X option that had existed since 2022. A federal judge blocked the policy that June giving folks an unknown amount of time to try to get a correct passport; in November, the Supreme Court let the administration enforce it, while the underlying case continues. Bottom line: right now, if you apply for a new, renewed, or replacement U.S. passport, you will most likely get one reflecting your sex assigned at birth, regardless of your gender marker history, your name change, or anything else on file. Passports issued before the policy shift, including ones with accurate markers or an X, remain valid until they expire — but anyone renewing, or applying fresh, is walking into this.

So picture the American trans person moving to Spain today. Their passport says one thing. They are another. Under the old system, that mismatch became permanent on their Spanish documentation the moment their TIE was issued, because the card was built to mirror the passport. Under the new protocol, they have an actual administrative door to walk through: present evidence that current U.S. policy makes it impossible to get an accurate passport, let the Foreign Ministry confirm that, and get the TIE corrected.

What is still unknown

This new process is less than two weeks old as I write this, so there aren’t any stories yet of how this plays out in real-time.

This appears to be strictly a fix-it-after-the-fact process. Nothing in the news or the Interior Ministry’s announcement suggests a trans applicant can request the correct marker at the visa application stage, before ever setting foot in Spain. The documents named — TIE, CRUE, and the rest — are documents Spain has already issued. My assumption is that the initial TIE will still be built off the passport and the correction happens as a second step once you’re here and holding that first card.

Nobody yet knows how strictly Spain will interpret “acredite la imposibilidad legal o de hecho” — proof of legal or factual impossibility. There are jokes about bureaucracy and paperwork here. (Watch this to get an idea!) Will a valid U.S. passport reflecting sex at birth, plus a copy of the State Department’s own policy, be sufficient? It seems like it should be — the policy is public, documented, and unambiguous. But “should be” and “will be, on the first try, at every Brigada de Extranjería office in the country” are two different things, and I’d bet on at some regional inconsistency in the early months at the very least.

There’s also no published timeline for how long the Foreign Ministry’s impossibility report takes to come back, unlike the one-month guarantee built into the standard domestic process. Anyone counting on this for a specific timeline — a school enrollment date, a job start — should build in slack.

To be clear about what kind of slack we’re talking about: this is a bureaucratic delay, not a discrimination risk. The Ley Trans doesn’t just cover the Registro Civil and identity documents — Article 13 already requires schools, from primary through university, to use a student’s or teacher’s chosen name and gender on rolls, class lists, and day-to-day records, independent of what their legal documentation says. Employers with more than 50 workers are separately required to have an LGTBI equality plan in place, including a harassment protocol. So while the TIE correction winds through Extranjería, a trans kid enrolling in a Spanish school or an adult starting a job isn’t supposed to be misgendered or misnamed while they wait — that recognition is already the law, separate from whatever the little plastic card says. The TIE mismatch is a problem for the moments where the government specifically demands the card that matches the passport — banking, certain contracts, anything requiring formal ID verification. A headache, but only a temporary one, and a headache in a country that won’t tolerate discrimination if you must out yourself by showing an incorrect ID.

Where this leaves you

If you’re a trans or nonbinary American weighing a move to Spain, or already there and stuck with a TIE that doesn’t reflect who you are: this is real, meaningful progress, and it exists because someone was willing to sue rather than accept “the system doesn’t work for you.” It is also brand new, untested, and likely to be applied unevenly at first. Go in with your documentation organized — your passport, any prior name-change paperwork, and a printed copy of the State Department’s current passport policy — and go in with patience for a bureaucracy that is, for once, actually trying to do right by you, even if it hasn’t fully figured out how yet.

I’ll be watching how this plays out in practice, and I’ll report back as people start actually using it. If you’ve gone through this process — or attempt to in the coming months — I’d genuinely like to hear how it went. This is the kind of on-the-ground detail that official announcements never capture, and exactly the kind of detail that helps the next family walking this path.

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She grew up in Princeton, New Jersey, and later in Santa Fe, New Mexico. She had a transcendent singing voice — that is the word her family used, transcendent — and she was admitted to the New Mexico School for the Arts, where she studied until 2024. She loved weather. She loved philosophy. She worked summers as an usher at the Santa Fe Opera, standing in the wings of one of the most beautiful outdoor venues in the world, listening.

She had been accepted to the University of Washington, where she was studying Atmospheric Science and pursuing minors in Music and Philosophy. She loved Seattle. She was, by every account, exactly where she wanted to be, becoming exactly who she was meant to become.

On the night of May 10th, Mother’s Day, she went to do her laundry.

She was found in the laundry room of her off-campus housing complex shortly after 10 p.m., stabbed more than 40 times. A suspect has since been arrested and charged with first-degree murder. Investigators are still working to determine whether the attack was targeted or random. I’m not sure if the answer to that question changes anything about what I feel.

Her family’s obituary described her as someone who was “courageously living her life as who she was until it was cut tragically short.”

I have read that sentence more times than I can count in the past few days. I keep reading it because I recognize it. I know what it costs to live courageously as who you are when the world is telling you, in law and policy and rhetoric and now in federal counterterrorism strategy, that who you are is a problem. I know what it takes. I know what parents pour into their LGBTQ children to find and own that courage, trying to build it strong enough to hold.

I haven’t been able to read much of the coverage. I’ve had to stay at a distance from it in a way that doesn’t feel like I have a right to do, but that feels necessary for my own survival right now. So please understand that what I’m writing here is not comprehensive reporting. It is a parent trying to put something into words that may not have the necessary words.

My child, Avery, turns 19 in a couple of weeks.

Avery is trans. Most of you know that — it’s been part of my public life and advocacy work for years. What I want to say here, today, is something I don’t always say out loud: there is a specific terror that comes with parenting a trans child that does not go away when they grow up. It simply changes shape. It follows them to college and into adulthood and into every space you can no longer control or monitor or protect.

We left the US and moved to Spain partly because of that terror. We watched the legislative landscape in the States escalate beyond anything I thought I’d see in my lifetime, and we made a decision to take Avery somewhere safer. I believe we made the right decision. I carry the grief of the families who couldn’t or can’t make that choice, or chose differently, every single day. Many stay because they are in “safe states”.

But here is the thing about Juniper’s story that keeps stopping me cold: she was in Washington state. Washington — one of the most protective states in the country for LGBTQ+ people. She was at a university whose president, in the aftermath of her death, made a point of acknowledging that violence against a trans person carries a specific weight for the LGBTQ+ community. She was not in Texas, Florida, our home state of Missouri, or one of the states whose legislatures have spent years making trans people’s lives smaller and more dangerous. She was in Seattle. That’s where my grandma — the only affirming person on my side of our family — lived. I always dreamed of moving Avery there. Juniper was there. She was in what was supposed to be a safe place.

There is no safe enough. That is what I keep coming back to. There is better and worse, there is more protected and less protected, there is legislation that helps and legislation that kills. All of that matters enormously and I will never stop believing it matters. And also: there is no guarantee. There is no city, no state, no country, no campus, no laundry room that can be made perfectly safe for a trans person living courageously as who they are in a world that has decided their existence is a debate.

I don’t know how to hold that. I’ve been a parent of a trans kid for a long time. I’ve never found a way to hold it.

Juniper’s family released a statement and an obituary in the days after her death. They named her. They described her. They told the world about the Santa Fe Opera and the weather obsession and the transcendent voice. In the middle of the worst thing that can happen to a parent, they made sure the world knew who their child was — not just how she died.

I think about the strength that requires. I think about it and I can’t fully get there in my imagination. I hope I never have to find out whether I have it.

The University of Washington called this the first student homicide in campus housing in its recorded history. One student, a freshman, told a reporter: “For me, thinking about it happening on Mother’s Day, and that girl is someone’s baby — her mom had to get that news.”

Her mom had to get that news.

On Mother’s Day.

I don’t have a way to move past that sentence. I’ve tried several times to keep talking about her family, and I keep stopping there.

I have spent years writing about anti-trans legislation. I have tracked bills and testified and trained advocates and tried to explain, in language accessible enough for people who don’t follow this closely, why it matters. Why the words in laws matter. Why the rhetoric of politicians matters. Why calling trans people a threat, or a contagion, or a disorder, or a terrorist ideology has consequences that land in real bodies in real places.

I believe all of that. I will keep believing it and writing about it and talking about it.

And I also know that Christopher Leahy — the man charged with Juniper’s murder — was not, as far as we know, acting on a legislative agenda. We don’t yet know why he did what he did. The investigation is ongoing. I’m not going to draw conclusions that the evidence hasn’t drawn.

What I can say is this: we live in a country that has spent years telling people, in increasingly official and explicit language, that trans people are dangerous, deviant, a threat to children, a terrorist ideology. We have a counterterrorism strategy that says so in print. We have politicians who built careers on it. We have media ecosystems that profit from it.

And then we ask whether a killing was targeted or random, as if those are the only two options. As if there is no third category: a culture so saturated with contempt for trans lives that the question of motive almost becomes secondary to the question of conditions.

I don’t know how to write that without it sounding like I’m making a claim I can’t support. So I’m writing it as a question I can’t stop asking, not a conclusion I’ve reached.

Avery turns 19 in a couple of weeks. They are alive and safe and becoming who they are becoming. And now they are doing all of that in a country that sees them, in a place and culture that doesn’t treat their existence as a debate.

Juniper Blessing was 19. She was alive and safe and becoming who she was becoming, in a country that was supposed to be better than this, in a place that was supposed to be safe, in a laundry room in her own home.

I don’t know how to hold both of those things at once. But I think I have to try. I think we all do.

Her name was Juniper Blessing. She had a transcendent voice. She loved weather and philosophy and the Santa Fe Opera. She was courageously living her life as who she was.

She deserved so much more time.

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