As a Therapist, I See the Damage of Anti-Trans Hate Firsthand

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uring Pride last summer, I was having lunch with a friend of mine, a trans man who’s been living his truth for decades. The Proud Boys’ attack on the San Lorenzo library’s Drag Queen Story Hour had just happened earlier that day, and he was telling me how frightened it made him. I was honestly taken aback: My friend, a very sizable man most people don’t read as trans, had never said anything like this to me in all our years of friendship. It was telling that, even in the Bay Area, he no longer felt safe.

At that point I wouldn’t have imagined that, less than a year later, a high-profile speaker at last week’s Conservative Political Action Conference would call for what amounts to the eradication of trans people. It’s clear that my friend was not afraid because of an isolated incident, but rather because of a pattern of bullying and abuse that has been directed at trans people for years, and is reaching a fever pitch.

In the pages of The New York Times and comments on TikTok, anti-trans rhetoric has become a full-blown moral panic, spreading complete falsehoods about trans people and the lifesaving medicine we use to be our true selves. And on top of the cruel cultural backlash, to date, nearly 400 bills have been introduced in state legislatures in 2023 seeking to criminalize or otherwise restrict the lives of transgender and gender-nonconforming (GNC) people. This represents a significant increase over 2021 and 2022, years that set records for legislation aimed at the trans community.

Taken together, these unprecedented attacks on transgender medical care, rights and culture have had enormous impacts on trans and GNC people, as well as the mental health providers who serve them. Reported rates of depression, anxiety and suicidality among trans people have sharply increased, and advocates say this is a direct result of recent hateful legislation. The mental health clinicians who serve these communities in red states are experiencing increased burnout, and personal attacks against these professionals have led them to fear for their own safety.

The same is happening here. As a transgender therapist dedicated to serving my community (in addition to my many cisgender clients), I have seen myself and many of my colleagues struggle to cope with the new onslaughts against trans people. Although the Bay Area — an ultra-liberal bubble within a sanctuary state for trans medical care — is often thought of as insulated from these assaults, the fact is that these laws are already having real and detrimental impacts on trans people here, and the therapists who support them.

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usanna Moore, a Bay Area clinical psychologist who began serving trans people in 2009, has seen the enormous good that therapy can do for her young clients. “It’s a real privilege to empathize with someone who is trying to feel at home in a self that is not well held by the wider society,” Moore said. “Therapy is also a place where the parents can see their kids really cherished for who they are. That helps the parents stay with their best selves and keep protecting, supporting and nurturing their kids.”

As the climate around trans people has deteriorated, Moore has seen it restrict futures and take away hope from her clients. For instance, a couple of years ago, when the legislative assault against trans people was just beginning, Moore had a teenage client tell her that they chose not to “look into any colleges back East because they’re trying to kill me there.”

Another teenage client had decreased their social anxiety due to gender-affirming medical care, but is now struggling again. “I tried to reassure him about California laws, but he just looked at me like, ‘Yeah, what if they change?’” Moore revealed.

There’s good reason for trans people to be anxious about the legal landscape. Legislation targeting trans people has been varied and extreme: The Florida State Senate recently proposed a new law that would take transgender children away from parents who validate their identity. Virginia introduced a policy to essentially force educators to misgender and deadname their trans students. Multiple states are again proposing bathroom bans, for the first time since the disastrous failure of North Carolina’s bathroom ban in 2016. States are eroding and attempting to eliminate the ability of trans people to get proper identity documentation. The list goes on.

In this era of anti-trans panic, even constitutionally protected freedoms of expression are fair game: The nation’s first anti-drag law is now on the books in Tennessee. Although most drag performers do not identify as transgender, many see drag as an integral part of trans culture, and many of the anti-drag statutes are written so broadly that they may be construed as criminalizing the existence of trans people.

The attack on the San Lorenzo Drag Queen Story Hour that so shook up my friend is becoming normalized, as paramilitary thugs across America now routinely brandish weapons and threaten the lives of individuals who are simply wearing some flamboyant dresses and makeup.

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herapeutic placement specialist Shayna Abraham, who specializes in connecting high-risk minors throughout Northern California with residential care for severe cases of suicidality, depression and eating disorders, said the legislative and cultural attacks have had a very concrete, detrimental impact on her work. Abraham told me that before Utah enacted its recent anti-trans legislation — including an outright ban on gender-affirming medical care for minors earlier this year — she would frequently refer trans kids for residential treatment in the state’s many high-quality clinics. Now that option is unsafe for her trans clients.

“Utah is the best example because there are so many programs,” said Abraham. “My clients and their families will say, ‘I know I need help but I can’t go to Utah.’ It limits a lot of the parents’ options when they have to rule out certain states because they aren’t safe.”

Abraham also drew parallels between the legislative assault on women’s rights and that against trans people, fearing for cisgender women whom she might have once referred to clinics in certain states. “I’m also concerned for my families who have girls. I’m thinking, ‘Where is it safe to be a woman in this country?’”

Trisha Wallis, a licensed clinical social worker and clinical psychologist who has served trans clients throughout the Bay Area since 2014, similarly drew parallels between the current legislative assault on trans people and what she witnessed as an abortion rights activist in the early 2000s. “I watched many doctors get targeted, watched clinic staff be harassed, myself included,” she said. “This has a similar type of feeling to it. It’s that same sort of ‘I’m going to protect the children,’ but it’s not coming from a very principled place.”

While Wallis has seen some California medical providers double down on their support of trans minors, others have stepped back amid the growing backlash — she’s gotten hate mail herself. She feels growing concern that trans kids in California will face restricted access to necessary medical care. Moore has also seen increased fear among medical doctors providing gender-affirming care to minors.

“It makes me worry for the ability of people to have a choice and have access to care,” Wallis said.

Transgender medicine is considered essential, evidence-based medical care by the Endocrine Society, American Academy of Pediatrics, American Psychological Association, American Medical Association, and American Psychiatric Association among dozens of other organizations. Thousands of pages of high-quality research going back decades have documented significant, positive impacts on the lives of transgender people who access this medical care.

At least eight states have banned lifesaving medical care for trans minors, with more bans likely coming. Several other states are currently debating bans on such medical care that could extend to the ages of 21 or even 26, or eliminate such medicine entirely.

“Part of my role as I see it is helping people to have hope again, and for me a lot of this landscape feels hopeless,” said Abraham.

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rans activists are widely in agreement that the assault on the trans community is likely to get much worse in 2024, as transgender people will be enormously demonized during the congressional and presidential elections. In spite of the dire outlook for trans rights, Bay Area therapists and their clients strive to remain resilient.

“It comes back down to my values of love and equity and justice. That keeps me going because it’s just the right thing to do,” Wallis said.

Similarly, Moore remains inspired by her work, knowing what she does is invaluable for both trans people and their families. “Despite everything, there is still magic there, and there is joy, and I do believe that helps us get through the hard times.”

I have seen firsthand the difference that good therapists can make in the lives of trans people. Our work has always been crucial in lifting up this extremely marginalized community, and right now it is sorely needed. Our calling to serve people with empathy, kindness and hope has been politicized and turned into a dangerous pursuit by opportunists with hate in their hearts.

I simply want the opportunity to live in safety and help improve the lives of other people — whether trans or cis — free from the bullying, stigmatization and abuse that has been a constant in my life since childhood.

In 2023, in America, that really shouldn’t be too much to ask.

Veronica Esposito is a writer, transgender advocate and associate marriage and family therapist specializing in supporting transgender clients.