Your criticism, published.

I’m Isaac Saul, and this is Tangle: an independent, nonpartisan, subscriber-supported politics newsletter that summarizes the best arguments from across the political spectrum on the news of the day — then “my take.”

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10 days ago, I published a newsletter (and then a video) about the Dylan Mulvaney-Bud Light controversy.

While the story wasn't groundbreaking political news or a piece of important, nation-changing legislation, it was a look inside what has become one of the most intense culture war issues in America: Gender.

Ironically, I'm not a huge fan of summarizing my own opinions; but the gist of "my take" was that the Bud Light boycotters were overreacting, I could understand why some folks were annoyed or offended by Mulvaney's online personality, and I wished more of the people who had such strong opinions about transgender people would talk to each other.

I also alluded to two of my fundamental views: First, that the government should not be limiting the decisions Americans can make about their medical care and bodies — that any government prohibitions on gender-affirming care would be infringing on the freedom and civil liberties of transgender people, their families, and their doctors. Second, that believing such bans are unjust and unconstitutional doesn’t mean you have to have black and white views on how people exercise their rights — like whether gender-affirming care is always the right call for minors, or if trans athletes should always be competing in the divisions that match their gender identity.

As you can probably imagine, my take along with many of the pieces we cited from the left and the right drew very strong responses from people across the political spectrum. Throughout my time writing Tangle, I have often talked about the importance of allowing for disagreement, elevating a diversity of viewpoints, and accepting criticism. That’s why, following our coverage of controversial topics, I like doing editions like this where we share reader feedback and I respond directly to some of your criticisms.

Today, I'm going to share 13 of the notes I got, in full. Some are from trans folks, some are from parents of trans kids, some are from medical professionals, some are from people who once questioned their gender but no longer do, and some are critics of my writing from the right and left. New responses are indicated by bold font and page breaks.

I've corresponded privately with many of these readers, defending or clarifying some of my writing or pushing back on their arguments. To my great pleasure, I've landed in cordial, kind, and understanding places with nearly all of them. And today, rather than respond, I've chosen to let their feedback stand as it is. I don't think I should always get the last word on these issues, and I don't think I need to.

For many different reasons, I've also opted to keep all of the following notes anonymous, and in some spaces you'll see [REDACTED] details to protect the identities of the people who wrote in.

Finally, a note: The responses I got to this newsletter were some of the most moving, interesting, and thought-provoking emails I've received on a single topic in a long while. I know this edition is one of the longest we’ve ever run (it's about 6,000 words in total) but I think the content is both fascinating and informative. It's a look into the multitudinous viewpoints of the people in our country.

I strongly encourage you to read it in full.

Thank you so much for your newsletters. I love them. I am a psychologist (received my PhD in Counseling Psychology) that specializes in transgender care, so I have some thoughts about your recent letter.

Your comment about how “gender-affirming care” is not often the best route is misleading. First, you really should separate the concepts of gender-affirming psychotherapy and gender-affirming medical treatment (hormone treatments and/or surgery). These are separate types of “gender-affirming” care. Additionally, you should have differentiated between gender-affirming care for adults vs minors.

In regards to whether gender-affirming therapy typically “works”… It is by far the best approach to date (based on current research). In the course of gender-affirming psychotherapy, the therapist should take seriously the questions and descriptions the client has about their gender. This type of therapy can help decrease distress related to gender dysphoria. Also, therapists trained in this area should support the client (minor or adult) in gender EXPLORATION. No final decisions have to be made if the client is working with an ethical and well-trained therapist. This should help to address concerns about minors. Ethical therapists are there to support the minors in their questions and initial descriptions…. Not forward an agenda about surgery.

In regards to medical treatments for minors… Yes, minors’ descriptions of their gender identities can and do change and so surgeries should be approached with caution given this. This is not true for adults. Most peoples’ gender identities remain constant once they have come out to themselves and others. Medical care (such as hormones and surgeries) for adults is OFTEN one of the most effective treatments. Even with minors, there are times when they have had a lasting trans identity for years and throughout various contexts, and it might (yes we need more research here) make the most sense to go ahead with surgery in these instances.

Currently, many states require that a minor be seen by a therapist and that the therapist write a letter of approval prior to any hormone treatment or surgery. Whether this is enough to stop surgeries that someone would later regret is another issue. Both the doctor and the therapist should be warning the client about possible irreversible effects of certain medical treatments. I have always discussed this with clients, and my clients tell me their doctors discuss this with them as well. Of course, I cannot speak to the details of how trans youth medical care is always playing out.

My frustrations with this “political” conversation stems from the fact that people just love to have opinions before they even have all of the accurate research-based information or care to learn more from psychologists and medical doctors who treat this issue. Research is extremely clear on one thing that is relevant to our “culture war”: trans kids are dying by much higher rates of suicide when their experiences related to gender are met with rejection.

I am staunchly, 100% in disagreement with the transgender movement, and I do not think that transitioning is ever the right thing to do. I think this for two simple reasons: it's not how God made us, and it's not good for the people struggling with their gender identity.

And, having said that, I totally get why people want to transition, I feel great compassion for those who identify as trans, I don't see them as "evil" in the sense of being somehow worse than other broken human beings, I don't have trouble getting my head around why someone would do what they are doing, and I don't have any problem with the idea of having a beer with someone who identifies as trans and talking about this openly.

I sometimes feel like those of us who say "this is wrong" and also "this is destructive to you and I don't want it for you and I feel for you and I am happy to be in relationship with you" are an invisible middle. Just wanted to go on the record as saying there are some of us out here and I bet it's more than the vocal extremes make it seem!

Thank you for your care in writing this piece. My 15 year old daughter is transgender, and I live in [REDACTED], and I have honestly had some hard moments the last two weeks. My daughter (who has had her name legally changed just barely made it to hormone therapy before it was banned in [REDACTED], and has no plans for surgery), is actually absolutely fine through all this. She’s told me “I don’t want to be the person who changes people’s minds, I just want to be.” And she has said “If I was just born a girl, I could do what I want and no one would question it,” (speaking about skateboarding, wearing dresses and generally just treating this as if they have no gender).

The lack of understanding of the whole situation is bonkers to me. No one is forcing children into anything. We had to go through multiple doctors, therapists, and psychologists in order to get a diagnosis of “gender dysmorphia” before we could even THINK about starting hormone therapy. And I was shocked when, at the first appointment, they gave us paperwork recommending that we freeze her sperm, just in case her sperm is affected by the hormones and she wants to have children later. I mean, like duh. But I never thought of it and I’m so glad they did, even though it delayed her starting her treatment by about 2 weeks. She does have a girlfriend who has fertility issues already at 17, so this was way more important than I even thought. I just don’t get where people get the indoctrination and forcing idea.

I had tears in my eyes when I saw the subject of today’s newsletter. I know this is all disjointed but I guess I just wanted to share with someone. I not only live in [REDACTED], but in an extremely conservative county, and I am honestly terrified that one day, my baby who doesn’t want to cause a fuss, or protest, or change anyone’s mind, my beautiful girl who just wants to exist and be happy, that one day just her PRESENCE somewhere in public will be the last straw for one of these far right conservatives and they will just shoot her.

First let me give you my 30-second TED Talk entitled "Differentiating Sex, Gender and Sexuality As Conveyed Via A Domestic Plumbing Metaphor": Despite modern western society's tendency to shove sex, gender and sexuality into the same small box, ongoing research over the past century has shown what many other societies — among them Native American — have known for the entirety of their existence: they're not the same.

Here's a simple analogy: Sex is the plumbing in your house, whether it was original to when the house was built or was remodeled later. Gender is what type and style of fixtures you connect to the plumbing and how you decorate the room it's in. Sexuality is who you let use the plumbing.

Another way to differentiate those is that sex is between your legs, gender and sexuality are between your ears, and none of them predetermine any of the others. You're given a sex (usually after a quick eyeball of your crotch by a nurse in the delivery room) when you're born. [I'm not going to even start down the road of ambiguous genitalia or sex chromosomal differences, other than to say the standard "XX=female, XY=male" binary being pushed by so many nowadays is only true in about 90% of humans [ed: see note]. Later, if you're interested we can open up that can of worms.]

Editor’s note: In fact-checking this figure, the most reliable and most frequently cited statistic on the percentage of people with intersex characteristics that we found is 1.7%.

You know your gender by the time you're 6, and often as early as the age of 3. Ask a 4-year-old if they're a boy or a girl. They'll probably tell you. And if you ask them if they feel like a boy or a girl, they'll tell you that, too. Because gender is literally a brain construct totally unrelated to the crotch.  Sexuality is another brain construct, but it doesn't show up until puberty.

I was born with a penis, but I knew very early in my life that I didn't feel like what everyone told me was how boys felt, but I had to be a boy because I had a dick. And I lived with that because that's how it was, and there was obviously something wrong with me because I didn't really want to be a boy. I wasn't supposed to be, but I was. It was bad when puberty rolled in and gave me a big dose of MORE MALE. You're a man now! Aren't you happy? Nope. I lived for decades with a lot of shame that I wasn't normal and fear that I'd be found out and especially a huge helping of anger at society because I couldn't be who I knew I was and anger at myself because I just took it and accepted it instead of standing up for myself. Until finally, it got to the point that I simply couldn't carry all that shit, and I had a choice of either offing myself to stop it or transitioning to stop it. I chose the way that let me live.

I burden you with that sad shit because when it all happened, being transgender was considered to be a secret, a shame, a perversion. But it isn't. It's just another in the infinitude of flavors that humans come in. It's a normal way of being. It has a biological basis. It's not something to be hidden. Hell, left-handed people used to be cursed and hidden away, too. Not any more.

I can tell you that a 5-year-old knows what their gender is, even if it doesn't match their sex, and it has nothing to do with being gay or straight or bi or anything else. And today, it's OK for many of those kids (FAR from all of them) to tell their parents that they're different. Here's the thing about what happens then — what you're hearing from doomsaying anti-trans politicians and preachers is most definitely not true.

First, until a kid gets close to puberty, nothing goes on physically. Do they want to wear a dress and grow their hair out and be called Denise? Do they want to wear jeans and cut their hair off and be called Dennis? Who gets hurt by that? Certainly not the kid. Who gets hurt by preventing that? I know from personal experience that the kid certainly gets hurt. It's not just letting the kids run crazy.

There are therapists and experts who get consulted and who help. And it's all reversible. If the kid changes their mind — cut the hair, lose the dress, go back to being called Doug, done.

But then we start sneaking up on puberty, and the kid knows things are going to change. If the kid is still certain they're in the wrong body, a doctor (normally, one who specializes in pediatric endocrinology and treats transgender kids) will prescribe puberty blockers for this kid. These are drugs that have been in use to safely stop precocious puberty (in everyday kids) for decades. They're totally reversible, do no harm, and all they do is delay puberty. No changes, just delay.

This gives the kids an increased chance to see if they really, REALLY want to transition. Their bodies are essentially put on hold until they hit 18. And until they turn 18 and can make their own medical decisions, no competent doctor in the world is going to give children under 18 cross-sex hormones or surgically alter them in any way.

Tucker Carlson pumps out the panic about crazy doctors mutilating kids when the reality is that literally nothing happens. (Of course, 14-year-old cisgender girls can get boob jobs and nose jobs, but that's different, you know.)

The vast majority of doctors and therapists and every recognized actual medical and psychiatric organization in the world fully recognizes that method of treatment for trans kids. There is a medical standard of care (WPATH SOC) utilized for over 40 years for transgender people worldwide by every physician who actually cares about their patients. Those standards stipulate support and help, but no hormones, no surgery for kids. However, the rabid crazies want to make you believe that it's all forcing kids to change and get surgery so they can couch their arguments as "protecting children" instead of what they really are — "eliminating trans people."

The talibangelists lost their previous favorite target — gay folks — when gays were allowed to get married, so their new target is "icky trannies". They pretty much failed with their first bathroom bills — the only people who ever got called out for that were actual biological women who didn't look girly enough. Those women did some serious lawsuiting. And now we're here with the "no one can have any gender-affirming care of any kind" bills. Drag queens grooming kids (if you want to see grooming, watch “Toddlers and Tiaras”), doctors slicing up kids, trannies stalking women in the bathrooms. All as legitimate as a 3-dollar bill, but who's gonna check?

By the way, the percentage of kids that make it to the puberty blocker stage and then decide AS ADULTS after 18 to go on to transition is about 85%. And the regret rate for those who actually have gender confirmation surgery ("sex change") is less than 2%. For reference, the regret rate for non-trans cosmetic surgery is 40%, and the regret rate for bariatric surgery is as high as 50%. The hugely vast majority of transgender people are happy with the decisions they made to transition, but the "party of small government" now wants the government to not let those people actually decide what it takes to be happy. So, now the vote-driving outrage is trans folks. After all, they can't be any more than about 4% or 5% of the population, so they make convenient targets to whip up the base.

By day 4, post-conception, the human sex (male or female: nothing else with extraordinarily few exceptions, e.g., trisomy) is known. Everything “trans” is merely drama and, just like mask-wearing, it’s make-believe.