For some people, gender shifts over time, often through changes in one’s sense of self. A transgender man may realize they are nonbinary and stop hormone replacement therapy. A trans woman may face so much discrimination that she represses her identity. And some trans people medically reverse their transition to live as their sex assigned at birth.
These experiences are all part of a process known as detransitioning. Although detransitioning does not have a consistent social or academic definition, it generally applies to someone who has sought a gender transition and then stopped, shifted or reversed aspects of it. Their experiences offer a deeper look at how discrimination and gender norms impact our lives, how gender-affirming care can be improved, and how identity is perhaps more fluid than previously thought.
As experts work to understand detransitioners, their vulnerabilities and their highly individualized needs, their identities are being co-opted as part of a national campaign against transgender rights. Health care access and research are being blocked by politicians for both trans people and detransitioners — while anti-trans rhetoric puts everyone at risk.
The Federal Trade Commission and the Justice Department are investigating gender-affirming care as medical fraud, and they are rooting this effort in detransitioners’ stories that fit the narrative the Trump administration wants to advance. The White House wants the National Institutes of Health to study “regret” and “detransition,” even as it cuts any federal funding for researchthat mentions the word “trans.” The U.S. Department of Education hosted a “Detrans Awareness Day” event last March. Meanwhile, its functions have been severely undermined by layoffs and budget cuts.
The White House and agencies like the Justice Department claim that gender-affirming care is mutilating children, overlooking that young trans people live happily after transition and the studies showing that adolescents who regret transition are in the minority. Government officials describe trans people and detransitioners as victims of a medical conspiracy to boost profits and force gender ideology on families. Now, they are seeking evidence to prove those claims by subpoenaing hospitals for patients’ private data, including doctors’ notes, patient addresses and Social Security numbers.
Gender-affirming care has been broadly endorsed by the medical community for its effectiveness in treating gender dysphoria, a persistent distress felt when one’s body is out of sync with their identity. The 2022 U.S. Trans Survey, which polled over 92,000 trans and nonbinary people 16 and older, found that social and medical transition were profound sources of life satisfaction. Experts and advocates agree that more research and more understanding are needed to improve trans medical care. But under Trump, they also expect transgender and intersex health to keep getting worse, not better.
The 19th spoke with two detransitioners who feel harmed and usedby the Trump administration, which has positioned itself as a protector of those who detransition. Adriana lives in New York City, where she feels safe to express herself among so many LGBTQ+ people, but has struggled to access adequate health care. Ara lives in North Carolina, a state that has several laws restricting trans rights and health care access — and where support from a mental health program and her partner has helped her navigate the challenges of detransitioning. As politicians stoke fear about gender non-conformity, their experiences offer a deeper understanding of what it means to live authentically in a politically volatile time.
Still, more young people have been exploring their identities, expanding the boundaries of gender and adding to the cultural and social norms surrounding it. Detransitioners’ experiences are part of that social evolution. Their stories of regret and pain exist alongside stories of joy and empowerment — and these are all part of a journey of self-discovery that may have turned out to be more complicated than they initially thought. The question is, will elected officials support them on this journey or cause more harm?
‘Taking away trans health care is taking away people’s lives’
As providers of trans health care have become political targets, Ara Kareis’ own routine treatments have been disrupted.
‘I just feel like such a power source’
The joy that Adriana Del Orden feels in her body could have only come through exploring her gender. She’s tired of being told that she ruined her life.
The politics of detransition
Political rhetoric doesn’t capture the complexity of detransitioning — or what taking away health care means.
Here’s the latest signature. This was done on my iPad, which was a little sad for me because I hadn’t used it in over a month. I had to reboot my Procreate program, and there was some lag. Don’t worry, baby. Daddy’s coming home.
A hard part about writing my signature is controlling my arm and applying pressure. Someone mentioned that I should strum one of my guitars as physical therapy, but I think there are better exercises. Plus, not being able to strum a guitar only makes me sad. It’s almost as sad as not being able to draw.
So why did six Democrats (one Independent and whatever the fuck Fetterman is) cave in on the government shutdown? They had just overwhelmingly won elections in New York City, New Jersey, and Virginia last week. The public was correctly blaming Donald Trump and Republicans for the shutdown. Proof of that was Donald Trump’s fight with courts to prevent snap benefits from feeding the hungry. Are Democrats upset over flight delays? Are they afraid Thanksgiving would be ruined? What did they get for rolling over?
Michael De Adder correctly has them surrendering.
Fake cartoonists Margolis and Cox have them surrendering, too. I can’t tell what’s going on with the person in the left-hand corner because the artwork is so bad. Why didn’t they finish writing “government?” There is plenty of room.
In the new deal, SNAP and WIC will receive additional funding, and there are a few other modest concessions on spending levels elsewhere in the government. Laid-off federal workers will be rehired, and furloughed federal workers will be given back pay. But remember, this entire fight was over subsidies for the Affordable Care Act being suspended. In exchange for rolling over, Democrats got a promise from Republicans that there would be a vote on healthcare subsidies. Basically, Democrats got a promise from Republicans that they’ll think about it.
Ezra Klein, an opinion columnist for The New York Times, wrote,“This, in the end, is the calculation the defecting Senate Democrats are making: They don’t think a longer shutdown will cause Trump to cave. They just think it will cause more damage.”
I understand why Democrats may get that impression. Donald Trump is flying to Asia, playing golf, traveling to me MAGA-Lardo, going to football games for no fucking reason, and ramping up support to name the new stadium in Washington, DC after him, and it’s obvious he doesn’t care about people starving. So what does Trump care if the government shuts down? And what do Republicans care either? They’re all on vacation. Mike Johnson sent Republicans on vacation. They want Democrats to own the shutdown, but they’re not doing anything to end it.
It is especially frustrating because these Democrats have been in Washington, DC long enough to know better than to trust Republicans. I wouldn’t be surprised if Republicans never even hold a vote on the subsidies for the Affordable Care Act. I mean, House Republicans did not make this deal, so they don’t have to hold a vote on the subsidies. Only Senate Republicans have promised to hold a vote.
Kicking Lucy’s football is a lazy trope, but John Darkow has it right that Democrats are nothing but a bunch of suckers.
Chuck Schumer did not vote for this plan, but do you blame him as the Democratic Senate leader for it happening, as Dave Whamond has cartooned about here? Personally, whether Schumer deserves part of the blame or not, doesn’t matter in concerning his fate, as he has always been a weak leader.
Democrats have the view that Donald Trump is not caving, thus they’re caving into in without even negotiating. Are you telling me that Donald Trump’s strategy of not giving a fuck is working to sway Democrats?
Chris Britt has it right that these eight are nothing but a bunch of chickens.
Mike Luckovich sure this cartoon last week or so, but now I believe it’s the Democrats, who are curving themselves up. If nothing else, they’re serving Obamacare up for the slaughter.
I don’t think anyone has explained the healthcare subsidy situation better than Matt Davies has. As someone who is benefiting from Obamacare and government subsidies, I feel like we’re getting rolled over.
And Steve…
I know you get reprints when you don’t blame anyone specific, but it wasn’t just Congress that was responsible for the shutdown. Maybe someday you’ll be able to cartoon about issues after you understand them.
This was almost as cowardly as…
…when Ramirez was afraid to blame Donald Trump for pardoning George Santos. Seriously, Michael… “they” did not pardon George Santos. Only one person could have pardoned George Santos, and I don’t know if you know how the Constitution works, but it doesn’t say that person is “they.”
Was Rudy Giuliani guilty of trying to help Trump steal the 2020 election? Donald Trump thinks he is. That’s why he got a pardon this week. This isn’t like Joe Biden giving his son and Dr. Anthony Fauci pardons, Fauci being preemptive, because Donald Trump has proved those were necessary as he has turned the entire Justice Department into his personal attack dog, and is ordering it to go after his political enemies and seek revenge. But nobody was really going after Rudy on criminal charges in federal courts. A pardon does not save Rudy from paying out the civil judgment from the Georgia election workers any more than it stops his farts or black shoe dye from running down his skull.
Bill Bramhall, who was a couple of days after Lucko’s turkey, caught that this pardon was in the right season.
Along with Giuliani, Trump pardoned John Eastman, a corrupt lawyer who advised Trump’s 2020 campaign; Mark Meadows, the former White House chief of staff; Boris Epshteyn, a presidential adviser; and Sidney Powell, an insane lawyer who blamed conspiracy theories for Trump’s defeat to Joe Biden. None of these people has been charged in federal courts, though they have been charged in state courts. Trump’s pardons are only symbolic as they don’t protect his friends from state charges.
This is another example of Trump using the presidency to help himself and his friends and not the American people. This is what happens when a felon gets pardon powers.
I’m sick of the new normal, which includes pandering to a 79-year-old toddler. Part of this new normal is naming shit after Trump. There’s talk of renaming the Kennedy Center after Donald Trump. There’s talk of renaming the metro system in Washington, DC after Trump, the $1000 savings account for newborns is called the Trump account, lawmakers had proposed renaming Dulles International Airport after Trump, and now, Trump is demanding that the new football stadium on the old RFK Stadium site be named after him. Donald Trump didn’t have anything to do with securing the stadium deal any more than he did with ending the war between Hamas and Israel.
As for the Metro, a Republican introduced a bill that threatened to withhold federal funding for Washington’s rail system unless the name was changed to the Trump train. Why? There’s no fucking reason given for this fealty to Trump. Republicans want to hold funding hostage, not for any policies or improvement, but just to name the system after Donald Trump. I seriously doubt Donald Trump has ever taken a ride on the Metro.
As you may know from reading this blog, I love Subway systems. I use the Metro more than any other train system, and it’s one I know very well. I will take it as a personal insult if the name is officially changed to the fucking Trump Train. This will be an insult to the entire city of Washington, and no longtime resident of the city will ever refer to it as the goddamn Trump Train.
I have said it before, and I will say it again. This is some Saddam Hussein-level bullshit. Of course, Republicans don’t care about the optics anymore.
I’m very surprised the Supreme Court refused to revisit gay marriage. You know if zealots Clarence Thomas and Amy Coney Barrett had their way, they would try to overturn it the same way they did with Roe. Precedent doesn’t mean anything to the Supreme Court anymore. Neither does the Constitution nor the law. SCOTUS would rather go by the Old Testament than by the United States Constitution.
Donald Trump is promising tariff payments to middle-income Americans. He said, “We’re going to issue a dividend to our middle-income people and lower-income people of about $2,000. And we’re going to use the remaining tariffs to lower our debt.”
Two things: this contradicts his argument that tariffs are not taxes being paid by American consumers, and his tariffs aren’t bringing in enough revenue to give everyone $2,000. If you make Americans pay these tariff dividends from the budget, then aren’t Americans paying for the dividends just like they’re paying for the tariffs? Donald Trump doesn’t even have any details for this new plan. He thinks it’s magic money that’s going to appear out of thin air.
Donald Trump wants the tariffs to pay off the deficit. American consumers are paying the tariffs. Donald Trump wants to pay American consumers out of the debt for paying for the tariffs. You don’t need to be an economics major to know that this is madness.
As Bill points out, it’s the tariff, stupid. If Democrats do come out winning over Trump’s tariff policy, I’m sure they will find a way to blow it.
Donald Trump is now demanding that the BBC apologize to him for editing part of a video of his speech before the January 6 attack, and to pay him lots of money, or he will sue them for $1 billion. This sounds like Dr. Evil threatening the BBC.
As Jack points out, ethics are lapsing with the American media. Now, when 60 Minutes interviews him (after CBS allowed him to bribe them), it’s about as ethical as when Fox News does not give him follow-up questions.
Trump believes the video made him sound more violent than he really was, ignoring that the attack on January 6 was violent and an attempt to overturn the 2020 election. But as usual, Donald Trump is demanding to be bribed. The American press has failed to stand firm against Donald Trump and his threats, so I hope the British press does not give in. I need to believe in something.
Joel Pett points out what Donald Trump wants edited out.
This is one reason why I like to have the BBC as one of the four channels in the multiview feature.
Have you heard of Mar-a-Lago face? Usually, people who have a little work done don’t want to advertise it. Most people lie about it when questioned. But now it seems that they’re all going the Kristi Noem route, and going for the Melania. Having your lips filled and being proud of it is very much a Palm Beach thing, but now it’s extending to Washington, DC. Now there are MAGAts in Washington who are having work done, and they’re proud of it. They want everyone to know, which means their faces look fucking stupid. It seems the facelift of Washington isn’t just going to be in the city. I guess collagen-filled lips are better for kissing Donald Trump’s ass with. Dammit, that’s a political cartoon.
If I see a bunch of Kristie Noems on the “Trump Train,” I’m going to lose my shit. Last June, during Trump’s birthday parade, I did tell some MAGAts on the metro to fuck Trump. A MAGAt’s right to free speech to wear that ugly cap on the Metro also applies to my free speech to tell them to go fuck themselves.
Let’s talk about some stroke stuff. I am currently wearing a temporary heart sensor. I hate it. Since I got out of the hospital, it’s been the bane of my existence.
Please watch. As she says the site is called Dunning Kruger and states it is not fake news or lies because it is totally fictional and made up. But tRump believes it. Hugs
The shutdown is over.Well, not officially, but it’s over. Seven Democrats and a Dem-caucusing independent caved, providing Republicans with the eight votes necessary to shove through a funding bill that will eventually reopen the government.
Once again, Republicans’ will to do the wrong thing was greater than Democrats’ to do the right thing.
Amazing how often that happens. With Medicare-for-all. With Senate representation for Puerto Rico and D.C. With revamping the U.S. Supreme Court. With simply seating a properly nominated Supreme Court justice.
Every single time, when the fight got hard, there were just enough Democrats willing to tuck tail and run to give Republicans another win. Just enough Democrats willing to believe that this time the GOP Lucys won’t move the football.
It’s coming again, sure as you’re reading this.
There will be no negotiation over Affordable Care Act subsidies—the lone concession that Democrats received for their spineless fold. Anyone with a working brain can see the end of this thing.
Republicans are going to renege. There’s going to be shock and outrage. Republicans and their media partners will not care. They’ll spin it in the dumbest possible way. Four million Americans will lose health care coverage. The costs of insurance premiums will go up substantially for all of us.
It’ll probably end up being Obama’s fault somehow.
Because this is how bad the Democrats are at messaging. Even when every single fact is on their side—and the facts were decidedly on their side—they can’t even get their own caucus to buy in.
I want you to consider what was happening. Take a step back. Consider all of the facts. And behold the breathtaking failure that the Democrats snatched from the jaws of accomplishment.
You have a country that is extremely angry with its current president, because that guy has failed to do anything that he promised he was going to do. (Probably because he lacks both the intelligence and the will to do any of those things.) This guy, whose policies have driven up prices and bankrupted American farmers and businesses, was publicly snatching food from the mouths of hungry children and poor people. At the same time, his party’s disastrous spending bill, which included ridiculous tax breaks for the wealthy and corporations at the expense of health care subsidies for the poor and working class, was in the beginning stage of jacking up monthly premiums from barely affordable to “I guess we’ll just die” rates.
For 41 days, the Democrats told everyone who would listen that they simply could not stand aside and allow this pain to fall upon good Americans. That this was a fight they wouldn’t abandon. That this was a fight they were in until the end.
Or until the airports got real busy.
I mean, people starving because food stamps were cut off was one thing. But long lines and cancelled flights, pfft, what are we, some sort of third-world country?
So, seven of them caved. Like sniveling, pathetic cowards.
Because more wasn’t demanded of them.
I’ve been preaching for some time now about the absolute necessity of researching and voting for the right people. For not simply voting for the party-affiliated candidate. To demand more. To vote for the people who best represent you and who have the best answers to your issues.
For most of you, particularly the working class and poor, that will be a Democrat. It just needs to be the right Democrat. We have to stop electing weak, ineffective, soft candidates, and choose people who will fight with intelligence and grit.
Look, let’s keep in mind the reality here. The things that were at the center of this fight—food stamps, health care subsidies, Medicaid, Medicare, Social Security—none of them would exist without Democrats, without a progressive party that governs based on morals and decency. A party that made sure the poor have food on the table and access to medical care. A party that said senior citizens deserved to live with dignity and some security.
But what happened with the shutdown cave should highlight the fact that it’s not enough to simply elect Democrats. You have to demand more. You have to demand a commitment, a willingness to fight.
Anything less, as we’ve seen, is just a waste of everyone’s time.
The shutdown may finally be coming to an end. Our health care costs, unfortunately, will not. I’ll be back on Wednesday with a deep dive into just how spectacularly absurd our health care system has become.
In the meantime, RSV and flu are picking up speed, and a concerning infant formula recall has been linked to a rare botulism cluster, thanks to a small but mighty team in California. The FDA is expected to remove the black box warning from hormone replacement therapy—a move that’s scientifically sound but bound to spark drama from HHS. We also have new blood pressure guidelines that could make prevention a lot more personal. And amidst it all, a few more pieces of genuinely good news to end on a high note.
Let’s dive in!
Disease “weather” report: RSV and flu gaining momentum
It will take some time for the CDC data systems to ramp up again after being offline for over 40 days. For now, we’ll continue to rely on the alternative sources, such as Dr. Caitlin Rivers’ updates and the PopHive dashboards.
RSV continues to climb slowly but steadily, especially among children under five. National growth is still linear—not yet exponential—but that acceleration could occur at any time.
Theflu remains relatively low but is beginning to increase, particularly among young children. As Dr. Rivers notes, “Hawaii has moved to moderate activity, Arizona has surpassed its seasonal baseline, and New York cases jumped 49% in the past week.”
Source: New York State Department of Health Respiratory Surveillance Report
U.S. childhood flu vaccination rates have dropped from 62% to 49% over the past five years. Last year saw one of the deadliest seasons on record, with 280 pediatric deaths—the highest since tracking began in 2004. About 90% of those children weren’t fully vaccinated. Our deadliest flu season came at a time of historically low vaccination rates, which can’t be a coincidence. We don’t yet know this season’s coverage, but if it falls further, we could be facing another tragic record.
Covid-19 remains in a lull, though we typically see a winter rise starting in mid-to-late November.
I’m really hoping these three viruses don’t peak simultaneously. Hospitals strain under just a bad flu season; I couldn’t imagine the “big three” all at the same time. Historically, their peaks have staggered, but given how little we truly understand about these overlapping patterns, that may have been more a matter of luck than a rule. Time will tell.
What this means for you: This is the best time to get vaccinated. It’s certainly not too late.
Infant formula outbreak and Listeria in pasta
Over the weekend, a troubling cluster of infant botulism cases was linked to ByHeart Whole Nutrition Infant Formula. Even during a government shutdown and an increasingly challenging environment, outbreak teams have been working around the clock to protect our most vulnerable.
What this is: Infant botulism is extremely rare but serious. It occurs when Clostridium botulinum spores—commonly found in soil, dust, and some foods—germinate in a baby’s intestines and release toxins that can paralyze muscles, interfere with breathing, and require intensive care. In a typical year, the U.S. sees 160–180 cases, often linked to environmental exposure or foods like honey. Even a small cluster of cases is a clear red flag.
What we know:Clostridium botulinum spores have been detected in ByHeart infant formula, resulting in the hospitalization of 13 infants across 10 states. The California Department of Public Health (CDPH) played a key role in identifying this cluster. CDPH is the only source in the world for BabyBIG—the lifesaving antitoxin—and manages all clinician calls and treatment distribution. Their team noticed a spike in requests and discovered that the affected infants all consumed the same formula brand, prompting an alert to CDC. Importantly, ByHeart produces just 1% of U.S. infant formula, so this alone is unlikely to cause a national shortage. (Be sure to sign up for YLE CA for a deeper dive this Thursday.)
What we don’t know: Epidemiologists are investigating whether contamination is truly confined to ByHeart or reflects a broader issue in the manufacturing or ingredient sourcing process.
What to do:Stop using ByHeart Whole Nutrition Infant Formula immediately. Retailers should pull it from shelves, including Amazon, Kroger, Walmart, Whole Foods, Target, and Sam’s Club.
There is also the ongoing Listeria outbreak associated with frozen pasta dishes, including some sold at Trader Joe’s and other grocery chains. We’ve covered this before, but according to the agency’s ongoing investigation, two more brands of food are linked to the outbreak. There’s a long list of recalled products you can find here. Throw out immediately.
In total, there have been 27 illnesses reported, 25 hospitalizations, and six deaths in 18 states since late September.
Number of cases associated with the pasta Listeria outbreak. Source: CDC
HRT ‘black box’ warning may be gone soon
Word is that the FDA will remove the black box warning from hormone replacement therapy (HRT) this week. (It may now be pushed back with the government reopening.) If this announcement reflects the HRT review conducted at HHS last month, it will likely be messy and riddled with inaccuracies. However, if you look at the science without the drama, removing the black label is not unreasonable.
The black box warning—the strictest warning label, meant for drugs with potentially life-threatening risks—was enacted after a 2002 Women’s Health Initiative study found increased risks of stroke and breast cancer. Since then, research has revealed crucial nuance: risks depend on timing, dose, and delivery. Starting HRT earlier, using low-dose or localized estrogen, and tailoring therapy to each woman can be both effective and safe.
What this story is really about: Menopause is universal, yet too often misunderstood. While the science continues to evolve, the major problem is that clinical practice and training have lagged far behind. Women deserve evidence-based care, informed clinicians, and the freedom to make choices rooted in both science and compassion. We are still far from what is needed for women.
POLL
(snip-poll won’t embed here; go to the Substack page. The question is if readers would like to see a deep dive into HRT. If you wish to vote, click “read on Substack”, above.)
New blood pressure guidelines
Major new blood pressure guidelines dropped for the first time in years.
At the center of the update is an enhanced assessment tool called the PREVENT calculator, developed by the American Heart Association. It’s designed to estimate a person’s 10-year risk of cardiovascular disease using factors like blood pressure, cholesterol, smoking, and diabetes. The model was built using data from 6.5 million U.S. adults aged 30 to 79, making it one of the most representative tools available.
Here’s what stands out:
A new threshold for medication. The key number to watch is 7.5%. If your 10-year risk of heart disease is at or above that level, physicians are now encouraged to consider medication even if your blood pressure hovers around 130/80 mmHg. If your risk is below that, lifestyle changes, like healthy eating, exercising, and better stress management, remain the first step.
A focus on home monitoring.The guidelines also emphasize checking blood pressure at home. Growing evidence shows that home readings may actually be more accurate predictors of long-term risk than in-office measurements. So spending $45 on an arm monitor if you have hypertension might be a great (even lifesaving!) idea.
What this means for you: This makes heart health more personalized than ever. You can calculate your own 10-year risk using the PREVENT calculator (although you will need some pretty specific numbers from your last blood panel). Regardless, aim for blood pressure readings below 130/80, and use these new tools to guide smarter—and earlier—prevention.
Good news!
Here are some of the great things worth highlighting:
The American Academy of Pediatrics (AAP) is standing up for science. The organization filed an updated lawsuit last week against HHS Secretary Robert F. Kennedy, Jr., asking a court to disband a panel (ACIP) appointed by RFK Jr. and to overturn recent decisions made by that panel. Then, to proceed under court supervision. The legal move is a direct push to restore expert-led vaccine policymaking.
The Vaccine Integrity Project (VIP) is stepping up on Hep B. With the next ACIP meeting coming up in early December, where the agenda will likely include the Hepatitis B vaccine for infants, the childhood vaccination schedule, and HPV—VIP, an independent group of scientists formed in response to waning trust in RFK Jr.’s ACIP, is conducting an evidence review ahead of what could be a contentious meeting. Their work helps ensure the science remains front and center.
Vaping among youth has seen a decline; but we still have a long way to go. A new study has found that the number of U.S. teens vaping has decreased overall. That’s progress. But among those who still do it, vaping is becoming more frequent and harder to quit—signs that use is shifting from experimentation toward dependence for some. If you have a teen who vapes, check out the EX Program, which is a free, anonymous text-messaging program designed specifically for young people who vape. There’s also SmokefreeTXT for Teens.
Question grab bag: You ask, we answer!
How long does the Covid-19 vaccine last? I got mine in September, do I need to get another?
A study published last week confirmed what we’ve consistently seen: protection against Covid-19 wanes over time. A study of more than 1.8 million Americans from the previous season showed protection against infection and severe disease declined after 4-5 months. The findings underscore the benefit of getting a Covid-19 vaccine every six months, especially for adults over 65, who accounted for nearly 80% of hospitalizations in the study.
In case you missed it
Help shape our AI + Health conversation. Thanks to everyone who responded to our survey last week! We’re running the AI and health survey to hear your thoughts on using tools like ChatGPT, Claude, Copilot, and PerplexityAI to get health information. If you missed it, take the survey here.
New York YLE’s Marisa discussed the state reaching a historic low in youth tobacco use.
California YLE Matt discussed the impact of ICE raids on access to healthcare.
Top Democratic officials put out a new guide, entitled “Deciding to Win,” that encourages Democrats to be a little more like Republicans on “identity and cultural issues.”
Left: David Axelrod // Public domain, Middle: James Carville // JD Lasica // Wikimedia Commons, Right: David Plouffe // Noam Galai // Wikimedia Commons
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This week, the self-styled centrist group WelcomePAC released a document entitled “Deciding to Win”—advised on by some of the Democratic Party’s most prominent strategists, including David Axelrod, James Carville, and David Plouffe—urging Democrats to act a little more like Republicans on so-called “identity and cultural issues.” The 58-page memo reads like a compendium of the consultant class’s worst instincts, encouraging candidates to become little more than poll-tested avatars and walking focus groups, trading conviction for triangulation. While the document rarely defines which “cultural issues” it means, the few times it does make it clear: queer and transgender people stand to lose the most if this vision of the Democratic Party takes hold.
The document begins with five key pillars for the party. Some of them make a lot of sense, such as “messaging on an economic program centered on lowering costs, growing the economy, creating jobs, and expanding the social safety net,” critiquing “the outsized political and economic influence of” the “ultra-wealthy,” and support for a $15/h minimum wage. Others, though, encourage the party to abandon platforms that have been central to its identity and mission to protect the most vulnerable in society, calling for the party to “Moderate our positions where our agenda is unpopular, including on issues like immigration, public safety, energy production, and some identity and cultural issues.”
While the document rarely defines what “identity and cultural issues” means, the examples make its targets clear. Support for the Equality Act—legislation that would codify gender identity and sexual orientation as protected classes under federal law—is cited as proof the party has “moved left.” Another section lists “protecting the rights of LGBTQ+ Americans” as a priority voters supposedly don’t want Democrats to emphasize. Elsewhere, a discussion of how to mobilize voters “sitting on the couch” reveals that the most popular policy among them is “defining sex as binary and based on biology at birth across federal agencies.” Later in the document, it explicitly calls out transgender sports participation as an issue that the party should “moderate” on.
Screenshot of Deciding to Win Chart of “moderate” policies
Imagine a world where Democrats actually heeded this advice. The “define sex as binary” policy—already championed in Republican-led states and now embedded in everything the Trump administration does—has had devastating consequences for transgender Americans. It has stripped trans people of the ability to update their passports, creating serious barriers to travel; defunded organizations that affirm gender diversity; and fueled crackdowns on college campuses that allow trans students to use restrooms matching their gender identity. It’s a policy of bureaucratic erasure, one that threatens to undo decades of hard-won progress—yet it’s presented, almost casually, as a “moderate” position Democrats might adopt to win votes.
It’s a vision of politics that would turn Democrats into little more than Republican Lite—a “big tent” party spacious enough for those who despise us but not for those who most need protection. In that world, Democrats would lose not just the meaning of leadership but the very soul of why the party exists. And it’s a fantasy built on delusion: no amount of fine-tuned messaging or poll-tested calibration will ever transform the party into the perpetual winner these consultants imagine.
We don’t have to imagine what happens when Democrats follow this playbook — we’ve already seen it. In New Hampshire, Democrats capitulated on multiple anti-trans bills, including bans on youth sports participation and gender-affirming surgery, only to suffer one of the party’s worst defeats of the 2024 election cycle, losing 20 seats. By contrast, Democrats in Montana fought hard against similar measures and mounted some of the most visible resistance to anti-LGBTQ+ legislation in the country, picking up ten seats in the state House—one of the party’s strongest showings nationwide, in a state Trump carried easily. In Kentucky, Governor Andy Beshear vetoed anti-trans bills, including a sports ban, and still won reelection in a Trump +31 state. And in New York, a ballot measure enshrining gender identity protections outperformed Kamala Harris’s statewide margin by a wide margin.
Despite the evidence, a faction within the Democratic Party still treats queer and trans people as expendable—convinced that by trimming the edges of equality and tolerating “a little” discrimination, they can win back power. It’s a ruinous illusion. This kind of triangulation doesn’t blunt Republican attacks; it validates them. Every state that once embraced sports bans or “compromise” restrictions has since escalated to banning medical care, censoring books, and policing bathrooms. Capitulation has never advanced LGBTQ+ rights—not in policy, not in public opinion, not once. Democrats aren’t losing because they’ve been too loud or too firm in defending equality; they’re losing because the far right invests in its own moral narrative while Democrats second-guess theirs. The only way forward is to stand unapologetically on principle—as Andy Beshear did in Kentucky, citing it as the very reason for his success—not to chase the approval of consultants who mistake cowardice for strategy and appeasement for leadership.
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America’s biggest export might soon be its own citizens. According to the American Psychological Association’s Stress in America 2025 survey, 63% of adults ages 18 to 34 have considered leaving the country this year because of “the state of the nation.” Among parents, more than half—53%—say the same.
These aren’t impulsive fantasies about Parisian cafés or permanent vacation visas. The study, conducted between August 4 and 24 among more than 3,000 adults, found that stress about the country’s future has hit a historic high. Seventy-five percent of Americans say they’re more worried about the direction of the nation than they used to be, and 76% call that fear a “significant source of stress.”
The anxiety isn’t limited to politics. Half of all adults reported feeling lonely, and 69% said they needed more emotional support this year than they received. “People are overwhelmed by societal division, technology, and uncertainty about what’s next,” said APA chief executive Arthur C. Evans Jr. “It’s affecting how they relate to each other and themselves.”
Almost Two-Thirds of Young Americans Are Thinking About Ditching the U.S. for Good
That division has started to show up physically. Among adults who named it a major stressor, 83% experienced physical symptoms in the past month, like headaches, fatigue, or anxiety, compared to 66% of those who didn’t. The same group was more likely to lose patience with family, cancel plans, or struggle to plan ahead.
AI is also creeping into the collective stress index. Fifty-seven percent of adults now say the rise of artificial intelligence adds to their anxiety, up from 49% last year. Among students, that number has nearly doubled to 78%. As automation expands and misinformation spreads, Americans are increasingly uneasy about how technology will reshape work, privacy, and even identity.
Still, the survey found that most people haven’t given up. Seventy-seven percent say they have some control over their personal futures, and 84% believe they can build good lives despite national instability. Family, friendships, and health remain top sources of meaning.
But optimism has its limits. Sixty-six percent of adults think they’ve sacrificed more than previous generations, and many feel the country isn’t keeping up its end of the bargain. For young Americans, especially, the American dream feels more like a relocation plan.
As stress levels rise and passports renew, the question hanging in the air isn’t whether they love their country, it’s whether they can still live in it.
WNV linked each of these. Here are the original pages with snippets.
After No Kings, It’s Time to Escalate by Eric Blanc
We need bigger—and more disruptive—nonviolent campaigns that can go viral and peel away Trump’s pillars of support Read on Substack
American democracy is on the ropes. Trump and his billionaire backers are doing everything possible to transform our country into an authoritarian state like Hungary or Russia, where the trappings of institutional democracy mask brazen autocratic rule.
Our president’s sinking popularity numbers might not matter so much if his administration is either able to ignore electoral results or to distort the electoral map so badly that there’s almost no way to vote Republicans out.
Far too many Democrats and union leaders naively hoped that the courts would save us. But the Supreme Court has given a green light to Trump’s power grab, and it appears poised to overturn Section 2 of the Voting Rights Act, the last major legal roadblock to prevent Republicans from disenfranchising millions of Democrats and Black voters across the South.
Are we cooked? Trump would certainly like us to believe he’s unstoppable. Faced with the administration’s relentless offensive against immigrants, free speech, public services, and majoritarian rule, it’s normal to sometimes succumb to despair. But there’s no need to throw in the towel — and there are concrete next steps we can all take to win back the country through nonviolent resistance. As Chicago Teachers Union (CTU) president Stacy Davis Gates reminds us, Trumpism “won’t be stopped just in the courts or at the ballot box.” (snip-there is MORE on the page linked at “Read on Substack” above)
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The introvert’s guide to fighting for democracy by Protect Democracy
Six ways to protect democracy — without attending a protest Read on Substack
If you’re reading this, you’re concerned about our democracy’s slide into authoritarianism — and you want to do something about it. Wahoo! You’ve taken the first and most difficult step: committing to action.
Now come the fun parts.
I want to be really clear on a couple things to start out. First, there is no one-size-fits-all best way to exercise your First Amendment rights of speech and association. Every successful social movement has employed a wide variety of tactics and repeatedly adjusted to respond to facts on the ground. Opt for action over agonizing about optimal tactics.
Second, be realistic. We are all busy. Reflect on the commitments you can actually sustain with room to grow. It is far better to regularly move the ball forward on a smaller effort than to dive into and never complete an ambitious one.
Third, be unique! You have unique talents, skills, and passions. Let those guide your advocacy. Focus on projects that bring you joy, things you actually look forward to engaging with week after week. Lean into the comparative skills and expertise you bring to the movement.
With all that in mind, here’s a short list of six ways everyone can protect democracy — even (especially) if going to a protest or some other more public form of engagement isn’t for you.
1. Check in with your local library
Local libraries are the backbone of an informed democratic citizenry, and they provide crucial resources for underserved communities. But their funding is under attack by the administration, which has cut critical funds nationwide.
So, give the library in your neighborhood a call. See how they are doing in relation to funding cuts and if there are ways you can support them. Do they take book donations? Need volunteers? See if there are teach-in or reading groups you can join — or even lead. Offer to help curate pro-democracy reading lists for various ages. Many libraries are open to suggestions for books to add to the collection — here are some recommendations from our team.
2. Fill the gaps left by government programs
Taking care of one another is essential movement building. Check in on your food pantry and community kitchen — many of which have faced funding cuts — to see how you can help. (snip-MORE at the page linked above: “Read on Substack”)
Left: David Axelrod // Public domain, Middle: James Carville // JD Lasica // Wikimedia Commons, Right: David Plouffe // Noam Galai // Wikimedia Commons
Scottie's Playtime 