Bans on Gender Affirming Care for Youth Reveal Purity Culture Is More Than Just an Evangelical Problem

Image: Juan Marin/Unsplash

On March 22, Wyoming became the 24th state to pass legislation restricting gender affirming care to youth. These bills follow a precedent set by Arkansas in 2021, where legislators passed the first bill of its kind. Although vetoes and court injunctions have permanently blocked Arkansas’s ban and temporarily blocked similar measures in some states, these bans are now active in many states. And, while the legislation isn’t generally couched in religious language, these bans impose a gender binary in which religion and law collaborate in creating something that structures all our lives. Some may not notice. For others, it’s unbearable. 

This is not a new problem. When the Defense of Marriage Act was overturned, Emily Greenhouse, writing for the New Yorker, argued that politicians enjoy pronouncing all four letters of the “LGBT” acronym while dropping the T in practice. This was certainly the case during the fight over transgender rights bills. Referring to them as “bathroom bills,” critics claimed that the safety of women and children were being threatened by the possibility that people of any gender could use any bathroom. More than a decade later, not only is the T still frequently being dropped, but that will remain the case as long as we continue, from bathrooms to ID cards, to organize ourselves around the gender binary. 

Writing for Type Investigations, Sarah Posner argues that bills banning medical care to trans youth are rooted in what she calls “baseless distortions of science and medicine.” Citing the American Academy of Pediatrics, the American Medical Association, the American Academy of Child and Adolescent Psychiatry, the American Psychiatric Association, and the American Psychological Association, Posner suggests that there is a clear medical consensus on the standard of care for trans youthincluding gender-affirming mental healthcare, puberty blockers, and hormone therapies. This medical consensus stands in tension with the ways in which the medical system itself continues to be organized around the gender binary. 

Nearly every medical form I’ve ever completed requires me to pick between some form of binary gender—i.e., “Are you a man or a woman?” On the rare occasion when a third box is offered, staff still misgender me, and use my legal name instead of the one I write over it. This even happens when I politely add “Preferred Name” to the form or scrawl “PLEASE CALL ME COOPER” above and around the space for the name. 

The bracelet they put on my wrist never says “Cooper” and I am required to repeat the name on the bracelet with each new encounter in which the words “name and date of birth” emerge from the mouth of someone pulling my wrist toward their face so they can see the letters printed on the band. Few bother to ask the full question, “What is your name and date of birth?” None want to hear something emerge from my mouth that doesn’t correspond to what’s printed on the band on my wrist. I too get bored hearing myself explain it over and over. So I don’t. 

We can and should point fingers at evangelical groups who train politicians to propose anti-trans legislation, but even mainline Protestant denominations cannot agree on pro-LGBT positions. About a quarter of congregations that had been part of the United Methodist Church disaffiliated over the past couple of years, a move that will presumably allow the adoption of more pro-LGBT policies at the much smaller General Conference of the United Methodist Church later this year. Also unable to achieve denominational consensus, the Presbyterian Church USA continues to allow local congregations to make their own decisions on LGBT issues. Arguments against LGBT inclusion often rely on the presumed naturalness of binary gender. Like evangelicals, they may quote Genesis 1:27, “male and female he created them.” Support for the gender binary is not a fringe evangelical issue.  

These ongoing realities reveal a more pervasive belief in the gender binary than the medical consensus Posner describes.

These more pervasive commitments to the gender binary are one of the reasons people who don’t consider themselves evangelical are taking up evangelical anti-trans rhetoric. Writing for Religion Dispatches this fall, Chrissy Stroop analyzed polling data that revealed the widespread impact of religious anti-trans rhetoric. “We’re now learning,” she writes, “that the deluge of disinformation and hateful propaganda is also having a negative impact on trans acceptance in the general public—even among progressive demographics.” And the reason religious anti-trans rhetoric can still be compelling to people who see themselves as supporters of LGBT rights is because we haven’t confronted the ways in which we continue to organize ourselves around the gender binary. 

The concept of social contagion, as understood by British anthropologist Mary Douglas, may help explain why these lawmakers want to keep trans people out of the social order. In Purity and Danger, Douglas claims that social boundaries are maintained according to ingrained ideas about purity and pollutionideas that are marked on individual bodies. This is why, according to Douglas, “a polluting person is always in the wrong. He has developed some wrong condition or simply crossed some line which should not have been crossed and this displacement unleashes danger for someone.”

In other words, individual bodies that appear out of bounds signal something wrong with more than that individual body; they signal a society out of control. Proposing laws that reinforce gender norms therefore reveal a desire to forcefully bring order to a society perceived to be out of control. 

This framework draws attention to the way in which trans people are perceived as contaminants that threaten social norms. Trans people threaten the gender binary and the institutions that depend on it, including medical ones. They can also confuse the expectation that people are quickly and easily categorizable according to gender. As people who “pollute” the gender binary, in part by revealing it as a construct, trans people are dangerous. And this is where Douglas’s framework again comes into play: The gender binary isn’t something natural, innate, or essential; it’s learned. And since children’s ideas aren’t yet fixed, there’s a possibility they may never learn. That, more than the specter of bathroom violence, is the threat trans people present to children. And that’s why so many of these bills target youth. 

Contemporary liberalism suggests that we can create a society in which everyone can be included, but it’s impossible to include trans people without reconsidering the ways in which we’ve organized our social institutions, including medicine, around the gender binary. When we try, we end up with inconsistencies, such as suggesting trans people are welcome while supporting argumentseven ones that come from the far rightagainst providing medical care to trans youth. If we continue to fail to consider the ways in which our basic ideas about gender structures our lives, we will continue to drop the T. 

This article was made possible in part with support from Sacred Writes, a Henry Luce Foundation-funded project hosted by Northeastern University that promotes public scholarship on religion.