Last August, Florida’s Medicaid stopped reimbursing patients for most forms of gender-affirming care. This is part of a larger push in the state to ban gender-affirming care, which transgender youth can no longer start receiving as of this past March.
But there is one kind of care for trans kids that the state seems to be in favor of. In a report on Medicaid coverage of gender-affirming care by Gov. Ron DeSantis and now-former Secretary of the Agency for Healthcare Administration Simone Marstiller, they noted gender-exploratory therapy as a treatment for adolescents who exhibit “gender identity issues.”
On its face, gender-exploratory therapy, or GET, sounds innocuous—even beneficial. This type of therapy is typically presented as a “neutral ground between the ‘radical’ gender-affirmative model and ‘unethical’ conversion practices,” bioethicist Florence Ashley wrote in a 2022 paper.
Yet GET is just conversion therapy by another name, said Shannon Minter, legal director of the National Center for Lesbian Rights, who has been advocating against conversion therapy for over a decade. Gay conversion therapy labels homosexuality as a mental disorder caused by issues such as childhood trauma, early sexual abuse, poor relationships with masculinity or femininity, and overlapping mental illnesses. Similarly, proponents of GET often point to issues such as unprocessed trauma, childhood abuse, internalized homophobia or misogyny, sexual fetishism, and autism as the “real” explanation behind one’s transgender identity, rather than accepting that a child who identifies as trans is sharing a real, deep, and even joyful truth about themselves.
As the anti-trans movement continues to grow nationwide, so does the popularity of GET. This treatment is taking root particularly in states like Florida that are trying to ban gender-affirming care for trans youth.
The Gender Exploratory Therapy Association, or GETA, asserts in their membership statement that “psychological approaches should be the first-line treatment for all cases of gender dysphoria” and medical interventions for children and teens “are experimental and should be avoided if possible.”
“We do not believe puberty blockers are a safe and appropriate option,” states a letter published in 2021 in the Lancet Child and Adolescent Health; the lead author, Stella O’Malley, is a member of GETA’s leadership team.
The idea that medical treatments for trans youth should be “avoided if possible” or even done away with altogether is not in line with the medical consensus in the United States. This care is evidence-based and medically necessary according to organizations including the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, the Endocrine Society, the American Medical Association, the American Psychological Association, and the American Psychiatric Association.
While proponents of GET are against medical therapies, they are adamant that they are not practitioners of conversion therapy. It’s the role of a therapist to explore someone’s inner self, and “this thoughtful reflection is intrinsic to the therapeutic process, but is currently in danger of being reframed as ‘trans conversion therapy,’ ” O’Malley wrote in an article published by the U.K. nonprofit Sex Matters. After President Joe Biden signed an executive order last June that aims to safeguard youth from conversion therapy—a practice that is banned in 20 states plus Washington, D.C.—a GETA co-founder stated that the order could have a “chilling effect” on GET practices.
Regardless of how they frame it for themselves, it’s hard to see what these therapists are in favor of, if not detransition (or clients never transitioning in the first place). GETA labels even social transitioning—adopting a new name, pronouns, and gender expression that match one’s gender identity—as “risky.” On their website, they state that “psychological interventions avoid the risks of social and medical transition” and “the significant medical, psychological, and social risks and unknowns associated with transition (both social and medical/surgical) require honest examination.”
Much like how a crisis pregnancy center steers pregnant people away from abortion, GETA’s strategy is to sound cautious and helpful while promoting a very specific view of how people should live their lives, which is as the gender they were assigned at birth, said Erin Reed, a legislative researcher, content creator, and trans rights activist who has been extensively following the rise of GET by tracking anti-trans individuals and organizations.
A look at an organization that is closely tied to GETA, called Genspect, reveals this belief. Genspect is a “gender critical” group that promotes GET; all of GETA’s leaders are on Genspect’s leadership team or serve as advisers for the organization. Genspect tweeted last year that “trauma, mental health issues, neuro diversity, and difficult accepting homo/bisexuality can cause gender distres [sic]” and that gender-affirming care should therefore not be available to anyone 25 years old or younger.
Genspect also supports an organization called Our Duty, which has stated that “it should be the objective of any advanced civilization presented with this problem to TARGET 100% DESISTANCE, and as early as possible.” Desistance means when someone stops identifying as transgender and pursuing medical transition.
When asked for an interview, GETA team member Joseph Burgo—who is also vice-director of Genspect—said that he and the rest of the GETA team declined to comment.
In contrast to the underlying assumptions of the GET model—that a trans identity is something that one might grow out of, with help—trans kids basically always continue to be trans. A 2022 study of 317 trans youths discovered that after an average of five years of socially transitioning only 2.5 percent of participants ended up desisting and identifying as cisgender. Another study published in LGBT Health found that 13.1 percent of people who identify as transgender have detransitioned—stopped or reversed their gender transition—at some point in their lives. It’s important to note that 82.5 percent of those individuals attributed that decision to at least one external factor such as pressure from family, non-affirming school environments, and sexual violence.
It’s impossible to know what happens inside each and every relationship between a trans child and a therapist who practices GET. But for activists and journalists who have been covering the issue, the overall trend appears to be clear. “The whole point of gender exploratory therapy is to delay, delay, delay, delay, delay,” said Reed. “The end goal is: You are not going to transition.”
Ky Schevers, a transmasculine person, was part of a support group that pushed many GET principles. Schevers formally detransitioned and helped spark the anti-trans movement, but has since recanted this view. “You’re basically picking yourself apart,” said Schevers of the GET experience. “You’re digging into yourself and dissecting yourself. It’s really dangerous to tell someone that their trauma made them trans.” In fact, those who have experienced conversion practices are more than twice as likely to report having attempted suicide than their peers, according to a 2020 study of over 25,700 LGBTQ individuals age 13 to 24.
In response to a Twitter call by Reed about individuals’ experiences with GET, actress and writer Jen Richards wrote that “a therapist I saw about gender dysphoria first diagnosed me as a ‘self-loathing homosexual,’ then said it was father issues, then that I’d created a separate femme self to blow off steam. We worked through all of it in earnest. Nothing changed. It delayed my transition by years.”
Anti-trans therapy didn’t appear out of nowhere, Ashley said. “It’s very much part and parcel of the broader backlash against transgender rights, which is itself part of the contemporaneous rise in very religious conservative, far right and, oftentimes, fascist politics.”
Any well-meaning therapist or parent who sees positive aspects to GET should also know that this therapy has been used by conservative politicians as part of a multipronged approach to banning gender-affirming care.
Last year, Gov. Greg Abbott sent a child welfare investigator to a family’s home after they provided gender-affirming care to their transgender child. The family sued Gov. Abbott and the Texas Department of Family and Protective Services. In court, the state argued that there are “alternative therapies” for gender dysphoria, with GET being one of the most common ones cited, according to Reed.
One reason why GET sounds so appealing to some parents is because they fear that gender-affirming health care providers are giving gender dysphoric children and teens puberty blockers or hormones far too quickly.
However, there are many barriers to gender-affirming care, including long waitlists, strict treatment protocols, and cost, leading many people to wait months or years for treatment.
Additionally, the affirmative care model already does include conversations about a patient’s desires and the impacts of various treatment options, both of which proponents of GET claim it leaves out. The standards of care set forth by the World Professional Association for Transgender Health state that health care professionals should undertake a comprehensive assessment of a teen’s “strengths, vulnerabilities, diagnostic profile, and unique needs to individualize their care.” This should be done prior to any medical or surgical interventions, and without this thorough assessment, “other mental health entities that need to be prioritized and treated may not be detected.”
Helping a kid with gender dysphoria is a long and thorough process, said Kimberly Vered Shashoua, a gender-affirming therapist who has been working with teens in this space for almost a decade. “I have sessions with the parent before meeting the child so they can ask questions like, What caused my kids to be trans? Or, My kid says they are trans, but what else could be happening?” she said.
Shashoua then offers a safe environment for the kid to explore their feelings around gender, rather than attempting to shuttle a child down the path to medical treatment as quickly as possible. “I tell them it’s totally valid to not have an identity that is static,” she said. “There is no downside to believing a child and making it totally explicit that I won’t be mad if they change their mind.” When asked if Shashoua has ever had a patient who came out as transgender and eventually grew out of this identity, she responded, “Not once.”
There’s no one right path of care for any given trans or gender-nonconforming child, Shashoua said. But what should be standard is that all children have access to accurate information, adults who will respect their identity, and treatments that are supported by medical consensus.
State of Mind is a partnership of Slate and Arizona State University that offers a practical look at our mental health system—and how to make it better.