Transphobes are actively curtailing improvements in trans healthcare, because any negative finding gets weaponized against access to care. It's having a chilling effect, at a time when many of us working in trans health want to push for improvements in how we deliver care.

Want an example? A few years ago I wrote this paper saying surgeons need to do a better job at informed consent. During peer review, one of the reviewers expressed fear that the argument could be weaponized to further gatekeep access to care. https://mjlh.mcgill.ca/publications/volume-13-issue-1-131-2019/surgical-informed-consent-and-recognizing-a-perioperative-duty-to-disclose-in-transgender-health-care/

And the thing is that I completely understand that fear. I know lots of people are too afraid to speak up about unethical practices because transphobes are only waiting to pounce and turn that 'do better' into 'no more care'. Which means having to endure them longer.

Ultimately, the paper was published. The reviewer and I both understood the importance of having this kind of work, and also knew that it was possible to be careful so as not to provide ammunition. Yet the fact that the question can even be asked is worrisome.

Trans people should have access to the best care possible. When we do have access to care, we don't have the best care. Part is cis people's ongoing stranglehold over trans health. But another part of it lies in how transphobes frustrate progress by forcing us on the defensive.

If transphobes cared about quality of care, they'd support trans health scholarship that aims at improving informed consent processes. They'd support attempts to undo the transmedicalist biases in trans health so that everyone can make their best decision. But they don't.

Want a tangible example? If your wait times are measured in years, there is so much stake in every appointment that it discourages folks who want to know more from asking questions and expressing doubts. Decreasing wait times not only eases suffering, but also improves decisions.

That's why I always point out that doing better for detransitioners isn't in tension with doing better for trans folks. Refocusing from gatekeeping to informed consent ensures that everyone makes the best possible decision for themselves. No one knows yourself better than you.