For those blissfully unaware of what’s been going on, let’s catch you up. The saga of Aldean’s transphobic comments began when she captioned a post on her Instagram by thanking her parents for allowing her to go through a “tomboy” phase and not “changing my gender.” In a later post to her Instagram Stories, she elaborated by spreading false claims about the medical procedures involved with transitioning as “the genital mutilation of children” and “one of the worst evils.”
“I will always support my children and do what I can to protect their innocence,” she wrote. “Some parents want to be accepted by society so badly that they’re willing to make life-altering decisions for their children who aren’t old enough to fully comprehend the consequences of those actions. Love is protecting your child until they are mature enough as an adult to make their own life decisions.”
It’s a stance she’s doubled down on in the weeks since — especially after being called out by country stars Maren Morris and Cassadee Pope. Aldean started selling merch to advocate her stance and raise money to combat “human trafficking and child exploitation,” claimed her comments were taken “out of context,” appeared on Fox News’s Tucker Carlson Tonight to claim that she is merely “advocating for children,” and that should an adult wish to undergo gender-affirming care, “by all means.”
That’s not how Laurel Powell, deputy director of communications, programs and the Human Rights Campaign, sees it. “There’s so much disinformation about who transgender people are, what life is like for trans youth,” she tells Billboard. “This is life-saving, age-appropriate, best practice care. ”
When discussions about gender-affirming care are brought up, the immediate attention is often paid to gender-affirming surgeries, in which people alter their bodies through plastic surgery, urology, gynecology or a number of other methods. This can include “top surgery,” in which a person has chest surgery to present as more in line with one’s gender, and gential reconstruction surgery, or “bottom surgery,” like vaginoplasty, phalloplasty, scrotoplasty or metoidioplasty.
But surgeries are far from the only kind of care being provided through these sorts of programs. Some young people don’t require medical intervention at all — instead, their care may simply focus on changing their gender expression by wearing clothing and hairstyles more commonly associated with their gender identity, or publicly changing their name and pronouns.
Dr. Joshua D. Safer, MD, executive director of the Mount Sinai Center for Transgender Medicine and Surgery, says that when medical intervention becomes necessary, there are a number of different procedures minors can undergo. Those who have yet to start puberty may begin their transition process using puberty blockers — medication meant to “pause puberty” for up to a year to prevent permanent physical change. Puberty blockers have long been used for cisgender patients experiencing puberty “before the medical system considers them socially ready,” he says.
When it comes to gender diverse people, puberty blockers can simply buy time before the patient decides how they want to proceed with their transition. “If puberty were not paused, irreversible physical characteristics from the natural puberty would occur and require more involved treatment later like surgery,” Dr. Safer explains.
Further plans can range from undergoing speech therapy to change one’s voice in accordance with how they want to express themselves, to gender-affirming hormone treatment (or GAHT), which introduces the hormones that match one’s gender identity into their body. And most of these treatments for adolescents are not permanent.
“Young people don’t do too much that is irreversible. Prior to puberty, there is no medical intervention,” Dr. Safer explains. “Even puberty blockers are reversible. In later teenage years, well-established patients may begin hormone treatment. Although there can be irreversible breast development (naturally or with hormones) or irreversible facial hair growth (depending on which hormones are being used), fertility remains intact and there is recourse.”
When it comes to gender-affirming surgeries, both the Endocrine Society and the World Professional Association for Transgender Health (WPATH) do not recommend surgical intervention before at least 18 years of age. They advise that if medical and mental health professionals agree that surgery is necessary for a minor, they must make sure informed consent is given. “Genital reconstruction surgery is typically reserved for adults,” Dr. Safer explains. “Prior to any gender-affirming medical or surgical intervention, all minors must have an intake with a knowledgeable mental health provider internal to our system. Once deemed ready for a medical/surgical intervention, the processes we have for adults are then brought into play.”
When it comes to Aldean equating her experience as a tomboy with kids struggling to figure out their gender identity, Dr. Safer says the two concepts are unrelated to each other. “Despite the words we use for it, gender identity mostly refers to the brain biology that lets you know what sex you are. It is part of biological sex,” he says. “Your gender expression and your view of gender roles are independent of your gender identity. That is, a person who knows she is a woman may have a ‘tomboy phase’ or express herself in ways that society may deem masculine, but that does not mean she is transgender.”
Most of Aldean’s concerns about children receiving this care are based on a hypothetical scenario in which someone receives some form of gender-affirmation surgery, only to later realize they do not identify as trans and regret having the procedure done. Dr. Safer says that’s hardly ever the case. “People who regret gender-affirming medical treatment decisions are rare and most often report the reason for their regret being lack of support from those around them,” he says.
Of course, Aldean’s comments are far from the only negative attention gender-affirming care has received in the last few months — more than a dozen states have proposed legislation to ban gender-affirming care like puberty blockers, GAHT and surgeries, claiming that such care amounts to “child abuse.”
Those continued efforts by right-wing organizations are part of an ongoing trend throughout the U.S. that Powell finds particularly disheartening. “There is a very well-funded, well-organized movement to try and drive a wedge between people and their LGBTQ+ friends, neighbors and family,” she says. “You look at what happened in Texas, for instance, where Governor Abbott has overseen one of the most aggressive campaigns to attack trans people specifically and LGBTQ+ people more generally. This is being driven by extremist legislators.”
In recent weeks, multiple children’s hospitals have been threatened with violence for offering gender-affirming care to their patients, including a bomb threat that was called in to Boston Children’s Hospital on August 30. “You have people who say, ‘Oh, I care about children,’ and then you see them doing things like calling in bomb threats to children’s hospitals,” Powell says. “If you really cared about healthcare for people, I can only imagine how many people’s healthcare was interrupted or harmed by a hospital having to close down.”
“I am mystified by threats to medical institutions that we all share for our health,” Dr. Safer adds. “It is not logical. I do not know why a vulnerable group would be targeted as if their health were a political topic … denial of such care or targeted attacks on trans people are not part of the establishment medical conversation on the subject. I don’t know why people outside of mainstream medicine have determined a need to attack this care or these individuals.”
Comments like Aldean’s are not threats of violence against trans and gender diverse people. But Powell points out that actively spreading inaccurate information, either consciously or unconsciously, can quickly lead to these kinds of horrifying results. The bomb threat sent to Boston Children’s Hospital, for example, came after a coordinated Twitter campaign by the far-right Twitter account Libs of TikTok, claiming that the hospital offered “gender-affirming hysterectomies” to minors. (A spokesperson for the hospital has since said that “we do not and have never performed gender-affirming hysterectomies for anyone under the age of 18”).
For Powell, the onus falls to media corporations like Meta and Twitter to crack down on the spread of disinformation on their platforms. “They just have to do more,” she says. “They have policies on their books that ostensibly are there to stop misinformation and prevent harassment of transgender people. But they are very unevenly applied, and you get situations where someone who builds an entire following around stoking outrage and anger is just allowed to continue to grow that, and to continue to find new ways to spread this disinformation to an even greater audience.”
Contrary to right-wing claims that this kind of care represents some sort of threat to children’s health and well-being, studies show that the opposite is true. In a peer-reviewed study published by the Journal of the American Medical Association Network (JAMA) in February 2022, 104 trans and non-binary youth were studied over the span of 12 months as they received care at the Seattle Children’s Gender Clinic. The study shows that the “receipt of gender-affirming care, including puberty blockers and gender-affirming hormones, was associated with 60% lower odds of moderate or severe depression and 73% lower odds of suicidality.”
Dr. Safer says that with the current lack of extensive gender-affirming care in the U.S., statistics also show just how detrimental not having access to medical treatment is for gender diverse people’s health. “Failure to provide gender-affirming treatment results in appalling mental health morbidity,” he says. “Because we’re still not providing sufficient gender-affirming care, we see mental health concerns in transgender people that are much higher than they need to be. But for transgender people who have gender-affirming medical care when they reach out for it, mental health disease is at a similar level to what is observed for non-transgender people.”
Organizations including the AMA, the American Academy of Pedatrics and the American Psychological Association all tout the importance of gender-affirming care for trans and gender diverse youths and dispute bans on transgender care in states like Arkansas. In 2021, the AMA sent an open letter to the National Governors Association, urging them to oppose legislation banning gender-affirming care, saying each bill “represents a dangerous governmental intrusion into the practice of medicine and will be detrimental to the health of transgender children across the country.”
With accredited medical organizations across the U.S. agreeing that gender-affirming care is not only beneficial, but often extremely necessary for the health and well-being of trans and gender diverse children, Powell says the discourse ought to end there. “Any time someone tries to put themselves into a conversation between a doctor, a parent and any young person, that extra person does not need to be there,” she says.
So, what can folks at home do to try and combat ongoing false narratives surrounding healthcare for trans kids? Powell says research is the key. “When you have questions about any other medical procedure, who do you talk to? Your doctor,” she says. “If you have questions about this, if someone in your family or someone you know has come out as transgender, check out what the American Medical Association has to say. Listen to the experts, because they know what they’re talking about.”
As for listening to influencers like Aldean, Powell cautions followers from blindly listening to what their favorite star thinks. “Don’t believe the first thing you see online,” she says. “Because it might just be completely made up.”