Dr. Katherine Gast had become accustomed to the odd social media comment or email from someone who does not support or understand gender affirmation procedures she provides to her transgender patients.
But Gast, a co-director at the University of Wisconsin-Madison’s UW Health gender services program, was blindsided by what happened when the social media outrage machine that has developed around transgender issues came for her.
On the afternoon of Sept. 23, a two-minute video of Gast describing gender-affirming operations was posted by the Twitter account Libs of TikTok, a self-described news service that acts as an outrage content factory for conservatives.
The account, operated by right-wing provocateur Chaya Raichik, captioned the video, “Gast happily describes some of the ‘gender affirming’ surgeries she offers to adolescents including vaginoplasties, phalloplasties, and double mastectomies.”
Raichik said in an emailed response to an NBC News inquiry that she stands by her characterization of doctors who work in trans health care.
Gast does not perform genital surgery on minors, and the word “adolescent” can mean anyone 10 to 19 years old, according to the World Health Organization. She performs what is known as “top surgery” in certain cases for older teens after evaluations by doctors and mental health care professionals, and then only with parental consent. Even so, the original tweet — one of eight that made up a thread about Gast and the patients she sees at UW Health — got nearly half a million views.
Within the hour, thousands of Twitter accounts had replied and retweeted Raichik’s thread, including that of Sen. Ted Cruz, R-Texas, who added an incendiary flourish, tweeting: “She does this to children. Sterilizes & mutilates them. Before they are old enough to consent.”
The reaction was immediate: Gast said a flood of posts across social media echoed the false claims about her clinical practice, posted private information about her and her family and demonized UW Health’s gender services program.
Being the focus of a national misinformation campaign and the online harassment it triggered was “scary and overwhelming” for Gast, her family and her colleagues, she said.
“The followers of LibsofTikTok and Ted Cruz lied about my practice to stir up outrage, doxxed me and my family, and my clinic is receiving harassing phone calls,” Gast said. “I can only imagine how scared our patients are feeling.”
Gast’s experience has become a predictable new cost for doctors who treat transgender patients. From Johns Hopkins All Children’s Hospital in Florida to Akron Children’s Hospital in Ohio and Vanderbilt University Medical Center in Tennessee, health care providers and institutions are being targeted as part of a new tactic in a larger right-wing war against LGBTQ people and communities, as well as the people and institutions who serve them. Before doctors, many of these same conservative online influencers and media figures targeted teachers and librarians, branding them as pedophiles or “groomers” over books, drag shows and Pride events, disrupting the goings-on at schools and libraries across the country.
The campaign has increasingly begun targeting individual doctors like Gast. It is a shift that has some health care advocates concerned about similarities to the anti-abortion rhetoric that spurred violence against abortion providers and clinics starting in the 1970s and continuing through recent years.
Most doctors have declined to speak after having been the targets of online harassment campaigns. Six hospitals and two doctors declined to speak with NBC News, citing, in part, threats of violence. UW Health has said its gender services program continues unchanged.
On Monday, the American Academy of Pediatrics, the American Medical Association and the Children’s Hospital Association released a joint letter to Attorney General Merrick Garland urging a federal investigation into the ongoing threats.
“These coordinated attacks threaten federally protected rights to health care for patients and their families,” the letter says. “The attacks are rooted in an intentional campaign of disinformation, where a few high-profile users on social media share false and misleading information targeting individual physicians and hospitals, resulting in a rapid escalation of threats, harassment, and disruption of care across multiple jurisdictions.”
The medical treatment of transgender children is rare. An estimate from the Williams Institute, a UCLA think tank that studies sexual orientation and gender identity law and policy, suggests about 1.4% of young people ages 13 to 17 identify as trans. Far fewer seek or have access to medical care, which can include counseling, the prescribing of puberty blockers and hormone therapy and in rarer instances — with parental consent and if conditional criteria are met — chest surgery. Guidelines supported by national medical organizations, including the American Academy of Pediatrics and the American Psychological Association, do not recommend genital gender-affirming surgery for children.
But the rate of trans youths’ seeking gender affirming medical care has increased in recent years, as noted in a recent New York Times article that showed the growth in the number of pediatric gender clinics in the U.S. and some research from the Netherlands and Britain. That growth, along with the increasing politicization of broader LGBTQ issues, has made trans issues a cause célèbre on the right. Republican lawmakers have proposed bills to limit or ban gender-affirming health care for trans minors in around two dozen states, according to an analysis by Bloomberg News. So far, conservative state and federal courts have blocked similar laws in Alabama and Arkansas.
Where legislative efforts have failed, the online fight against trans people and their caregivers is faring much better, said LGBTQ advocate Alejandra Caraballo, a clinical instructor at the Harvard Law School Cyberlaw Clinic.
“They can’t win through legislation,” Caraballo said in a phone interview. “They realize that the only way they can win is to pull a page out of the anti-abortion playbook from the ’70s and ’80s, where essentially they threaten and create security risks to hospitals.”
In recent weeks, influential accounts like Libs of TikTok and the smaller accounts they seem to inspire have focused on individual health care providers who treat trans people.
Conservative podcaster Matt Walsh went after Vanderbilt University Medical Center last month, claiming doctors “mutilate,” “castrate” and “butcher” children. The next day, Walsh appeared as a guest on Tucker Carlson’s show as Carlson projected photos of Vanderbilt University Medical Center’s board of directors, along with their names. The chyrons for Carlson’s segment read, “Vanderbilt ghouls castrate kids for big profit” and “We will show you who is responsible for this.”
Tennessee’s House majority leader, William Lamberth, tweeted in support of Walsh’s report, decrying “child mutilation,” and Tennessee Gov. Bill Lee called for an investigation into Vanderbilt’s pediatric transgender health clinic. Vanderbilt Medical Center responded with a statement saying that Walsh’s claims “misrepresent facts” and that the clinic requires parental consent to treat patients.
While some conservative politicians have echoed Carlson, others have more explicitly nodded toward calls for real-world violence. A day after Carlson’s show, Texas state Rep. Briscoe Cain tweeted, “Prison is too nice of a punishment for those who perform gender surgeries on children.”
Posts from large online accounts and right-wing media coverage often precede threats of violence downstream. Groups and individuals — online and off — have bombarded hospitals and providers with harassment and threats in recent months.
A tweet by influential right-wing accounts like Libs of TikTok causes a spike in mentions of specific doctors and hospitals across the platform, according to a report provided to NBC News by Advance Democracy Inc., a global research organization that studies disinformation and extremism. In many of the resulting mentions, the doctors are maligned as “child molesters,” “pedos,” “groomers” and “butchers.”
Advance Democracy identified numerous threats and calls for violence directed at specific doctors and hospitals that were posted to alternative right-wing platforms, including the website Patriots.win and the social media app Truth Social.
Asked whether it takes down threats of violence against individuals on its website, a spokesperson for Truth Social said in part by email that its app is “one of the cleanest and most family-friendly social media platforms in existence.”
Last month, as federal prosecutors charged a Massachusetts woman with making a bomb threat against Boston Children’s Hospital, an FBI agent confirmed the hospital had received over a dozen similar threats.
Twitter did not respond to a request for comment on Libs of TikTok or the larger anti-LGBTQ campaign targeting doctors and hospitals.
Twitter handed down a weeklong suspension to Libs of TikTok last week for violating its policies against hate speech. Upon being reinstated Sunday, the account posted a thread about Barbara Bush Children’s Hospital in Maine and tweeted: “No matter how many times they try censoring and silencing us, we’re never gonna stop the work we’ve started. We’re not going anywhere.”
By Monday evening, Libs of TikTok had been suspended for another seven days, according to Raichik’s business partner, Babylon Bee CEO Seth Dillon.
The threats alone can disrupt care. Trans patients have reported programming and procedures have been canceled in the wake of targeted online abuse. In addition, hospitals’ immediate response to such harassment is often to remove videos and materials from their websites that are being misused to fuel outrage. That kind of self-censorship may decrease online abuse in the short term, but, advocates say, it can also cut off initial points of information and contact for trans people seeking care.
Rachel Carroll Rivas, the interim deputy director of research for the Southern Poverty Law Center, a nonprofit group that tracks hate and extremist groups, said the “playbook” of targeting doctors has deep roots in the anti-abortion movement of the 1990s, which targeted specific doctors who provided abortions throughout the U.S.
“All of the same hallmarks of the anti-trans movement today happened then, in the ‘90s anti-abortion movement,” Carroll Rivas said. “The pseudoscience, the misinformation, the policy efforts to back it all up — it’s the usage of politics, the pulpit and the media to rile up extremist actors.”
Carroll Rivas pointed to a similar tactic used by the American Coalition of Life Activists, headed by Neal Horsley, an anti-abortion activist who died in 2015.
Horsley published a list called the “Nuremberg Files” on the coalition’s website, which displayed the names and addresses of doctors who performed abortions in the U.S., and crossed out names of those who had been hurt or killed.
Although Horsley did not openly advocate for the deaths of specific doctors, Planned Parenthood successfully sued the American Coalition of Life Activists and was awarded $107 million in damages in 2002 over the list, a verdict that withstood a lengthy appeals process.
Gast said she remains motivated to work with trans patients despite the harassment she faces.
“Everything that we do is about empowerment and resolve,” she said. “Our work allows so many people to live their best and most fulfilling life. Right now, we are focusing on our commitment to our patients and a resolve to be there for them.
“I want my patients and their families to know that I am here for them.”