A comprehensive proposal to address gender care in the United States. x.com/i/grok/share/f72282719…

Robert F. Kennedy, Jr. Secretary United States Department of Health and Human Services 200 Independence Avenue, S.W. Washington, D.C. 20201 Re: HHS Final Request for Information Regarding Sex-Rejecting Procedures on Minors Dear Secretary Kennedy: I am a private citizen, not affiliated with any of the organizations addressed by the above referenced request. However, I have been involved in care supervised by the documents at the root of the issues you seek to address. HHS has sent demand letters to medical organizations that had direct or indirect impact on gendered care, for minors and adults. There are specific accusations against specific organizations but generally the letters assert that HHS has documented substantial evidence of harm for minors from sex-rejecting procedures that the organizations have supported and provided. The evidence addressed patients from heterogeneous cohorts, with differing clinical presentations and treatment pathways. The guidelines at issue for that care impact adults also. I do not intend to address the specific allegations against any organization, but rather address the concerns that prompted the HHS to investigate the care category. The published letters to the organizations requesting current positions, proposed changes, and timelines gave the impression it was open to some discussion on the topic. The full letter: tracycoyle.com/distress/file… Attachments: tracycoyle.com/distress/file… tracycoyle.com/distress/file… tracycoyle.com/distress/file…

J.K. Rowling, your essay asks us to distinguish between wanting trans people dead and defending women’s rights. But that framing leaves out the question that matters most: what happens to trans people when the policies you support are implemented? You can sincerely reject violence while supporting restrictions that expose people to more harassment, greater vulnerability and fewer opportunities to participate in public life. Your intentions deserve an honest hearing. Your proposals deserve an honest assessment of their consequences. Death threats against you are wrong. Harassment of rape crisis services is wrong. Women’s concerns about privacy and sexual violence deserve serious consideration. None of those concessions establishes that your account of trans people is accurate, or that excluding us produces a safer society. You still have to demonstrate that. Throughout your essay, you describe trans women as men who declare themselves women, wear dresses and demand access. I am a trans woman who has undergone hormonal and surgical transition. My endocrine system, breasts and postoperative anatomy are physical realities. Hormonal treatment changes sex characteristics; surgery changes anatomy. The Endocrine Society documents these changes. You cannot give an accurate account of my body while reducing everything that happened to it to clothing and an announcement. That does not mean every characteristic changes, or that my reproductive history is identical to yours. It means that an honest discussion must identify which characteristics matter for the particular question being asked. Chromosomes, hormone levels, genital anatomy, reproductive capacity and physical strength are different things. Your essay repeatedly substitutes the word “male” for the work of explaining which characteristic creates which risk, under which circumstances. Consider the practical consequences of excluding trans women from women’s toilets and changing facilities. We still need to use toilets. We still work, travel, shop and attend appointments. Exclusion does not remove those needs. It leaves us choosing between men’s facilities, an alternative that may not exist, and avoiding the activity altogether. For a woman who has transitioned, entering men’s facilities can make her conspicuous and vulnerable. A private alternative can help when it is genuinely available, accessible and convenient. But promising that someone could theoretically provide another room is not the same as ensuring that one exists. A policy must be judged by the options people actually have on an ordinary Tuesday, including in small workplaces and older buildings. The available evidence gives you reason to take this seriously. A 2025 Williams Institute review reported that trans respondents living consistently according to their gender identity experienced more denial of access and verbal harassment when using facilities corresponding to their sex assigned at birth. The review also documented bathroom avoidance and consequences for participation in employment, education and public life. These are reported experiences, rather than proof that every restriction produces an identical result. They nevertheless expose a substantial omission in your essay: the people you propose excluding have safeguarding needs too. The foreseeable consequence is broader than an unpleasant bathroom visit. If someone cannot reliably use a toilet during a shift, their workplace becomes harder to navigate. If going out requires planning around the possibility of confrontation, public life becomes more restricted. Formal permission to hold a job means considerably less when an employer cannot provide a workable arrangement for a basic bodily need. Saying you oppose employment discrimination does not answer that practical problem. Then there is enforcement. How would your preferred boundaries operate? If staff rely on appearance, they will sometimes challenge cis women who look masculine and overlook trans women who do not. If appearance is insufficient, what information must a person disclose, to whom, and under what authority? Birth records? Medical history? Evidence of surgery? Your essay offers categorical confidence without an adequate account of how strangers are supposed to apply those categories. The foreseeable danger is that women’s facilities become places where people feel entitled to interrogate anyone they consider insufficiently feminine. That is an argument about the incentives your approach creates, not a claim that every supporter will harass someone. But those incentives matter. A safeguarding system should reduce opportunities for intimidation, including intimidation carried out in the language of safeguarding. Your argument about predators also sets an inadequate test. You ask whether someone has ever exploited trans inclusion. An instance of exploitation matters and should be investigated. But the existence of an offender does not, by itself, establish that excluding an entire population reduces overall harm. You need to compare policies: what each prevents, what each fails to prevent, and what new vulnerabilities each creates. Research examining Massachusetts localities found no significant increase in reported safety and privacy violations associated with gender identity protections in public accommodations. That finding does not establish zero risk everywhere. It does challenge the assumption that inclusion necessarily produces the danger your essay invites readers to expect. There is evidence pointing toward harms associated with restriction, too. A 2019 study of 3,673 transgender and nonbinary American adolescents found that school restroom and locker room restrictions were associated with higher reported sexual assault risk in several groups, including trans girls. The study was observational: it does not prove that the restrictions caused the assaults, or that those assaults occurred in bathrooms. But a discussion presented as concern for children’s safety should confront that evidence rather than treating exclusion as self-evidently protective. The same missing accounting appears in your discussion of rape support. Survivors deserve privacy, appropriate therapeutic settings and meaningful choices about their care. Some may need particular groups or arrangements. But trans women can also be survivors of rape and domestic abuse. Your essay discusses us overwhelmingly as a possible threat to survivors, with little attention to us as survivors ourselves. Funding a specialist service does not automatically mean opposing every alternative. But if exclusion is your preferred principle, you owe an answer about the remaining provision: where can a trans survivor receive timely, affordable and appropriate support? Is that service funded, reachable and able to accommodate her? An abstract assurance that trans people retain human rights does not provide a counselling appointment or a safe bed. The consequences depend on the actual service landscape, which your essay does not adequately examine. Prisons require equally serious attention. Nobody should place a dangerous prisoner among potential victims simply because that prisoner requests it. But placing every trans woman in men’s accommodation is also a decision with foreseeable safeguarding consequences. An adequate assessment must consider both the danger someone poses and the danger they face. Offending history, threats, vulnerability and the available secure accommodation matter. A label cannot do all that work. Your essay also treats recognising trans women as though it entails unconditional agreement on sports, prison placement, support groups and sexual attraction. It does not. These questions require separate reasoning. Nobody owes another person a date or sexual access. Recognising me as a woman does not settle every eligibility rule in every institution. By bundling those issues together, you make ordinary recognition appear inseparable from the most alarming demands you can describe. Your appeal to class makes the omission especially stark. Working trans people also lack private facilities, expensive lawyers and the financial freedom to leave hostile workplaces. We also rely on public services. When you describe inclusion as an elite luxury, you overlook the people for whom an ordinary, uneventful working day depends on it. A billionaire can insulate herself from many policy consequences. A restaurant worker generally cannot. The Supreme Court ruling does not relieve you of this responsibility. It interpreted the relevant terms in the Equality Act 2010 as referring to biological sex and affirmed continuing discrimination protections for trans people. That legal conclusion matters. It does not establish that every possible exclusion is beneficial, or answer every question about how people should be treated. Legal interpretation and an assessment of human consequences are different tasks. Finally, consider the consequences of your rhetoric. When ordinary trans women are repeatedly presented alongside rapists, voyeurs and men seeking access to women’s bodies, readers are encouraged to interpret our presence through suspicion. I cannot attribute a particular assault or harassment incident to your essay. But it is reasonable to scrutinise how that framing may legitimise confrontation and make collective exclusion easier to defend. You say you do not want trans people denied personal safety. Then personal safety must appear in the substance of your proposals. Explain how we can work, travel, use facilities, recover from abuse and navigate institutions without being placed in greater danger. Examine alternatives such as private changing options, adequate cubicles, effective complaint procedures and individual risk assessments. Show that your restrictions improve outcomes compared with those alternatives. You do not have to want someone harmed for your preferred policy to make their life more dangerous. Harm can follow from removing safe options, making services harder to reach, encouraging suspicion and leaving vulnerable people with nowhere workable to go. Your essay offers extensive reassurance about your motives. What it still owes trans people is a credible account of how we are supposed to live safely with the consequences.

You open by clarifying that you do not want trans people dead. Thank you for the spoiler. The rest of the piece, however, treats the existence of people like me (trans women who have medically transitioned, live as women, and ask only that our material reality not be legislated out of every public category) as an existential threat to the very concept of “woman.” That is not a statement of concern. It is a demand that we vanish into a pure biological definition you control. You repeatedly describe the “dominant strain of trans activism” as the claim that any man who declares himself a woman is literally a woman, entitled to every female space, every sports category, every rape-crisis room, and every lesbian’s dating pool. This is a useful caricature. It lets you collapse a wide range of people and practices into a single predatory figure: the heterosexual male who retains male pattern criminality, male strength, and male sexual orientation while demanding entry. Some such individuals exist. Some have committed terrible crimes. Safeguarding against them is necessary. What you refuse to grant is that this figure is not coextensive with the category “trans woman,” nor that the policy response must be the categorical erasure of sex-based recognition for everyone who has transitioned. I am a trans woman. I am also a lesbian and a mother of daughters. I have been on estrogen for years. I pass as a woman in public spaces. My body is not that of an unaltered adult male, and my social existence is not that of a man who has simply announced a new title. When you write that “if a man can be a woman, there is no such thing as a woman,” you are not describing a logical necessity. You are describing the conclusion you have already chosen: that any acknowledgment of transition must dissolve the category entirely. That is not how categories work when material reality is more complicated than the binary you prefer. Intersex conditions, hormonal variation, and long-term medical transition produce bodies and social positions that do not fit cleanly into the pre-transition male template you treat as permanent. Acknowledging this does not require pretending that sex is a costume or that every male who says “woman” must be housed in a women’s prison. It requires refusing the claim that the only alternative to total self-ID is total exclusion and denial. You note, correctly, that not all women are equally affected by these policies, and that elite women can afford private security and the luxury of abstract slogans. Working-class women and rape survivors cannot. This is true, and it is a reason for careful, case-by-case safeguarding rather than a reason to treat every trans woman as an undifferentiated male risk. It is also a reason to notice who else is made more vulnerable by the rhetoric you advance. Trans women are disproportionately victims of violence. Many of us are also survivors. The women-only rape crisis center you fund is a legitimate response to a real problem; the accompanying insistence that the only coherent feminism is one that defines us out of womanhood is not. When institutions over-reach (placing an intact male in a women’s prison or a rape-crisis role without regard to pattern of offending or medical status), they create the scandals you document. Those scandals do not license the reverse over-reach: the claim that any recognition of transition is “Stonewall Law” and must be rolled back in full. You invoke Orwell and the freedom to say that two plus two is four. The freedom to state biological facts is real and has been threatened in some workplaces and institutions. It is not the same thing as the freedom to decide, by fiat, that medical and social transition changes nothing about the person who has undergone it, and that anyone who disagrees is participating in a top-down elite plot to abolish women. Past movements for rights expanded recognition without requiring that the prior category be dissolved. (1/2)

HHS has demanded that six professional medical organizations provide evidence to support their official guidance regarding gender care for minors. That demand, for a response within 10 days, includes intended changes to that guidance and a timeline. I do not belong to, or represent those organizations, but I have prepared a response tracycoyle.com/distress/HHSi… - mailed to @SecKennedy and each of the organizations addressed. Mila Becker (Chief Policy Officer, Endocrine Society) @MilaNBecker Mark Hyman Rapaport, M.D. (President, American Psychiatric Association) @Pres_APA Willie Underwood III, M.D. (President, American Medical Association) @PresAmerMed Wendi S. Williams, Ph.D. (President, American Psychological Association) Asa Radix, MD, PhD, MPH (President, WPATH) @AsaRadix Mark Del Monte, J.D. (CEO/EVP, American Academy of Pediatrics) @AAPDelMonte Endocrine Society: @TheEndoSociety American Psychiatric Association: @APApsychiatric AMA: @AmerMedicalAssn WPATH: @wpath AAP: @AmerAcadPeds

Last week, United States Department of Health and Human Services sent letters to six professional medical associations/groups DEMANDING a response within 10 days that addressed the 'fact' that HHS had completed a review of gendered care for minors in 2025 that proved harm from the care the organizations supported and provided. The letters demanded the organizations provide evidence supporting their policies, what they were going to do in light of the HHS Review, and a timeline for changes. In several of the letters to specific organizations, HHS made accusations. I am not associated with any of the organizations, but I DID work on documents that addressed many of the concerns HHS noted. And, I responded as an individual. If you are interested in my response, and the documents I provided, follow the link: tracycoyle.com/distress/HHSi…

Tomorrow:

It is people like Mia and Wesley who point to Hunter and proclaim her a man, that are amongst those that damage girls and young women. Those girls and women will see how people look at Hunter and call her 'a man' and think, 'that is how people see me? I'm not anywhere near as pretty and SHE is being called a man. What does that make me?" The body shaming, the enforcing physical stereotyping, the absolute hate directed at Hunter is spilling over girls and young women. And they are paying attention.

I want to thank @BillboardChris for his posting on the HHS demand letters. It alerted me to them and allowed ME to prepare a package to respond. That package went out today. On Wednesday, it will be posted to my website for all to see. Sometimes, even those we disagree with, can provide a benefit.

You may need to hear this. Today's lesson about life.

Let me address his points: First, this is not a physiological issue - seeking an 'objective benchmark' is not the goal. The end point of transitioning is dependent on whom you talk to. To you, there is none. To the transgender it is to move away from their natal sex. To the gender incongruent, it is to resolve the inherent mismatch between the psychological foundation and the physiological sex to the extent that modern medicine can accomplish. So, only to you, is there no point. But, let's go on. What do you mean by 'change sex'? I am sure it is the impossible "from a fully functional male/female to a fully functional female/male". Only people such as yourself make the claim others seek this. There is a POSSIBLE 'change sex' when you address specific characteristics of sex: Four of the five CAN be changed, permanently - hormonal, gonadal, primary and secondary sex characteristics. The only one that can not be changed is chromosomal. 'altering people's body' seems to mean 'cosmetic surgery'. That is a LARGE medical business you seem to dismiss without consideration. The goal in THAT area is to make the patient happier. Apparently you have the opposite goal. Plastic surgeons are unscrupulous? Gee, I am sure some are, but most seek to help their patients - a goal you seem to reject as 'moving the goalpost'. Certainly 'do no harm' exists - but YOU don't get to determine the risk/benefit determination of every patient, forever. Just YOUR patients? I am sure many of them make a different choice that you would - or do you deny them out of hand? Supratherapeutic is inaccurate (a lie?). The goal is to have hormone levels consistent with the patient's age and health. As both estrogen and testosterone are normally produced by EVERY body, they are 'meant' for the body. And the body handles them just fine as the genes for protein encoding are on the X chromosome we all share. As to 'endless experimental surgeries', that is just an outright exaggeration. Revisions happen. I have a new shoulder joint - it will need work in about 15-20 yrs. Side effects of medicines ae common - and adjustment of soagages or alternatives are often available. Frankly, I am glad I am not around Colorado - as a patient, I'd avoid you like the plague. Your entire post reeks of unethical prejudices and disinformation. x.com/ColoradoDoctors/status…

Ideology as a method of dismissing an entire category of individuals. There is nothing redeeming in this approach.

Mia, you’ve written a conspiracy story in which every diagnostic change is a scam, every patient is duped, and every treatment is an atrocity. What’s missing is evidence establishing those sweeping conclusions. The American Psychiatric Association explains that gender dysphoria concerns clinically significant distress or impairment associated with gender incongruence. Being transgender does not automatically qualify someone for the diagnosis. Distinguishing an identity from distress is not declaring that every possible treatment is necessary, harmless or appropriate. That leap is yours. You acknowledge that the diagnosis focuses on distress, then pretend clinicians declared the distress healthy and stopped investigating. Which is it? A condition defined by clinically significant distress is hardly a proclamation that nothing needs assessment. “No need to investigate” is directly contradicted by the Endocrine Society’s published recommendations. Diagnosing clinicians should distinguish gender dysphoria from conditions with similar features, assess psychiatric conditions and evaluate the patient’s understanding and social circumstances. If a clinic failed to do that, document the failure. Don’t falsely describe the recommended assessment as nonexistent. And “you just chop off the body parts” is a sneering caricature of care that can include psychotherapy, hormones and surgery according to the individual’s needs. The diagnosis is not a surgical instruction. Your disgust vocabulary doesn’t establish whether a particular intervention was justified. Your conveyor-belt story about children being “ushered into operating theatres” also needs specifics: ages, procedures, assessments, consent and outcomes. The Endocrine Society recommends waiting until adulthood for genital surgery. Its guidance discusses adolescent chest surgery separately, with assessment requirements. Those recommendations don’t prove every clinic complied; they do expose how much your account leaves out. Then comes “social contagion.” You assert that a diagnostic change and media campaigning caused increased identification, improper diagnoses and unnecessary surgery. Those are several distinct causal claims. A sequence of events is not proof of the mechanism connecting them. Where is your evidence distinguishing that explanation from changes in visibility, willingness to disclose and access to services? As for billing codes: WHO openly explains that retaining gender incongruence in its classification supports access to healthcare and insurance coverage while moving it outside the mental-disorders chapter. That is a stated policy rationale, not a secret you’ve uncovered. Whether care is appropriate still depends on clinical evidence. My mental health improved substantially with treatment. You don’t get to erase that experience by describing my body and decisions in the most revolting language you can assemble. Name the intervention. Name the patient group. Show the harms, benefits, uncertainties and comparison with alternatives. Demonstrate the failures you allege. “Activist-crafted,” “contagion” and “amputation” are not substitutes for that work. You’re demanding rigorous scrutiny of medicine while expecting your own fucking claims to pass without any.

A high school physics teacher in Oklahoma showed a live SpaceX launch during class because it aligned with the unit on Newtonian mechanics. The students expected to be bored. A rocket launch is a rocket launch. Most of them had seen clips before. The booster separated. It flipped around. It fired its engines in reverse. And it landed upright on a drone ship in the middle of the Atlantic Ocean. The room went silent. Then one student said "wait, that actually just happened? that's not CGI?" The teacher rewound the landing footage and played it again. Then again. He played it 4 times because the students kept asking to see it. A student in the back of the room who had been failing physics all semester asked how the rocket knew where to land. The teacher explained thrust vector control, grid fins, and computational guidance. The failing student took notes for the first time all year. Actual handwritten notes. The teacher said afterward that nothing he had taught in 15 years of teaching produced that reaction. Not demonstrations. Not lab experiments. Not guest speakers. A live rocket landing on a barge in the ocean did in 30 seconds what his lesson plans hadn't done in a semester: it made a 16 year old who didn't care about physics ask how something worked. The student finished the semester with a C. Not remarkable on paper. But the student had been on track for an F and the inflection point was a 30 second video of a rocket landing that made the theoretical suddenly real. SpaceX doesn't have an education department. It doesn't fund classroom programs. It doesn't design curriculum. But every live launch that a teacher shows during class is the most effective physics lesson available to the American education system. The curriculum can't compete with a booster landing upright on a barge while 30 teenagers watch with their mouths open. The best physics lesson in history wasn't designed by an educator. It was designed by an engineer who wanted to reuse a rocket.

Is there a movement to ban abortions under the age of 26?

It is easy to dismiss the arguments of the transgender activist because they only see one side of the issue. Which of course is the problem with the arguments of those against the transgender activist issues. The Trump Administration is picking a side, and doing the same thing - dismissing the arguments of the opposing side. It is not an objective, honest, broker of the issues. No surprise that government is not just placing a thumb on the scales, it is dumping a truck load of rock on it. So, there is no resolution when both sides use, abuse, distort the same type of absolutism that is always, and without question, the wrong place to be. There are voices of reason on both sides - they are being drowned out by the activists of both sides.

A world of individual sovereignty: people free to live as themselves without coercion or ideology, left alone in liberty, with personal paths open and no forced conformity.

I've been tinkering with a longer piece about just this because a few years ago I infiltrated about half a dozen estranged parent groups on Facebook, and here's the short version of what I observed: - evangelical Christianity is by far the most dominant belief system. It almost goes hand in hand with parental self victimization - all coded language goes completely out the window when amongst themselves. "we weren't perfect" or "we made mistakes" becomes "we just don't accept our gay daughter" or "we don't approve of our sons transgendered lifestyle". - there is a pathological refusal to offer apologies to children. it is treated as a defeat as though they're negotiating with terrorists. - therapy as a concept is detested, for reasons that become quite obvious. The therapist is a third party who snaps the child out of the normalcy of tyrannical family dynamics, so they are in turn interpreted as a sort of overarching hand stealing their child from them. - these groups unanimously lean conservative, and most of its active participants are women. this is where the tears of grand/mothers are weaponized in an attempt to get what they want. - there is a hatred for the concept of "found family", or anything that diverges from the family unit. There is also hatred for any public support of estranged children, as anyone who receives it is accused of "replacing us with fans/yes men" - there is a contradiction in the parents desired interpretations of their personhood in nearly every post. I've read literally hundreds of multi paragraph long screeds about how their children must "see them as more than a mother/father and as people with flaws" while also saying they must "return to and honour their mother and father." There is a dissonance in wanting the forgiveness of a human but the authority of a tyrant. - colleges and universities are openly treated with skepticism, especially if the child moves away to attend them. there is a near total overlap in the child refusing contact once they experience the world freely. - there is a common assumption that the child takes pleasure in distancing themselves from their parents and that it is part of some liberal and/or secular brainwashing - prayer is commonly prioritized as a self soothing technique rather than meaningfully engaging with their children's pain - although therapy speak has absolutely become weaponized by a vocal few for political purposes, terms like toxic, grey rocking, trauma and narcissism are trigger words to the estranged parent. they lose all ability to engage once they hear any of these words. - somewhat related, there is a general denial around the prospect of unintentionally traumatizing your child. the accusation of such is an unbearable attack on the ego, hence why the most common experiences I read surrounded refusing to accept their gay/trans child, lifelong body/sex shaming or physical abuse. I have a much longer version of my findings in the works, but that is the gist. Nearly all estranged parents come cut from the same ideological cloth, like a toy store row of Buzz Lightyear boxes. There is an incredibly clear archetype in both the estranged child and parent: the child, who has been rejected for who they are and the parent who is more upset at being informed of their child's pain than the child's pain itself.

This is an extraordinarily contemptuous statement, Sharron. You want to argue about biological sex? Argue it. You want to argue for sex-based categories in sport? Argue it. But claiming that trans women are simply men “pretending to be a regressive & narrow female stereotype” isn’t a defence of women’s rights. It’s you presuming to know the motives, experiences and inner lives of an entire group of human beings. And what exactly is the “regressive female stereotype” they’re supposedly impersonating? Long hair? Dresses? Make-up? Femininity? Because women fought for decades against the idea that any of those things determine whether we are women. Yet here you are using precisely those stereotypes to ridicule another group. My daughter didn’t tell me at nine years old that she was a stereotype. She told me she was a girl. She didn’t transition to perform femininity for you, compete with you, threaten you or diminish your womanhood. She grew into herself. You don’t have to believe that sex changes. You don’t have to support trans inclusion in every sporting category. There are legitimate discussions to have about biology, fairness and safeguarding. But you can make every one of those arguments without reducing trans women to deceitful men playing dress-up. Once your argument becomes “they’re pretending”, you’ve stopped discussing policy or biology and started declaring that you know another person’s mind better than they know themselves. You don’t. My existence as a woman is not threatened by my daughter’s existence as a trans woman. Neither of us is a stereotype. We’re simply two women with very different life experiences, and neither of us needs you to define the other out of humanity.

Anyone (!) notice that: For decades people talked of 'gays recruiting kids'.... And now it is 'trans recruiting kids'.... But back then you could be 'talked out of being gay'... And now you can be 'talked out of being trans'.... Or that just, time and better environment, they'd grow out of it? If shaming and bullying were still around....

This is simply the best, and most consistent way, loving parents behave. Thank you.