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José E. Romero Martínez

Dr. J.D. Applen

ENG 6335

April 30, 2023

Kairos and the Opportunities for Gender-Affirming Care

In March 2023, a Florida House subcommittee passed House Bill 1421, a law that at-

tempts to go further beyond what the Florida Board of Medicine Established surrounding a ban

on gender-affirming care for minors seeking puberty lockers and hormone therapy. According to

this bill, it would give current patients until December 31, 2023 for the “gradual discontinuation”

of gender-affirming care, and “Doctors who violate the law would face a third-degree felony”

(Varn 2022). State Republican Representative Randy Fine, one of the bill’s co-sponsors, argues

that this proposal would “protect children” from potential harms, and even hinted that to be even

more restrictive (Varn). However, Kellan Baker, executive director of the Whitman-Walker In-

stitute, decried the bill as “a social experiment” that will have devastating consequences for trans

people suddenly forced to stop treatment. Also, the new law would forbid insurance coverage for

adults, forcing many to pay out-of-pocket for their treatment or forgo it altogether (Varn).

In 2022, Texas Gov. Greg Abbot ordered state child welfare officials to investigate po-

tential child abuse allegations on transgender children undergoing gender-affirming care. This

was prompted by a legal opinion from Texas Attorney General Ken Paxton which considered

gender affirming care as “child abuse” (Dey and Brooks-Harper 2022). (It is worth noting that, at

the time, both men found themselves facing Republican primary challenges, which they eventu-

ally won.) The legislation highlighted the ambiguity of trans children and their families who

might be forced to chose between continuing treatment or face an investigation that could lead
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into family separation or jail time (Dey and Harper-Brooks). Moreover, these actions create a

chilling effect that “stigmatizes an already marginalized group by normalizing speech and ac-

tions that target them,” even if such investigation have been rare in practice (Dey and Harper-

Brooks). The intended nature of these actions is to protect children from neglect or harm, but the

outlook amounts to a force of political opportunism in a vicious cycle that feeds upon itself:

Dubious, unrepresentative, or entirely made-up anecdotes are trumpeted across

right-wing media, prompting conservative legislatives to place strict limits on
transition care for minors, or ban it entirely—or […] ban transition care entirely
even for adults. They are attempting to shove trans people back into the closet, if
not prevent them from existing. (Cooper 2023)

What has been referenced by some to protect children from committing life-altering deci-

sions has been confronted by doctors and activists as the making of a moral panic, an antithesis

to a course of treatment that is “universal, pervasive, well-studied, and simple” (Hancox-Li

2023). The ongoing legislation against gender-affirming care has become an extension of a po-

larizing, hyper-partisan culture wars between the intersections of trans rights, gender identity,

gender expression and sexuality in America. This also means that analyzing the discourse sur-

rounding events within a specific period provides greater opportunities to wade beyond the noise

and understand what makes these rhetorical arguments compelling. Understanding kairos, or

“the right word at the opportune moment,” empowers others to proactively engage with complex

questions that can better appreciate the needs of stakeholders and activists within he diverse

needs of a discourse community (Foster 2005).

Kairos and the Rhetoric of Science

According to a detailed explanation by Crowley and Hawhee, kairos differs from chronos

in the intent of its measurement; whereas chronos refers to the “linear, measurable time” we are

used to tracking with numbers, kairos represents a “situational kind of time” that opens itself up
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through a specific opportunity (38). In this way, kairos observes two specific roles for rhetors: it

provides a window of opportunity towards discussing a pressing issue or expose an ongoing ar-

gument; and it provides an inventive upon which rhetors to position themselves towards (Pou-

lakis, qtd. in Foster 2005). Kairos can also be both fickle and fleeting, or enduring and unrelent-

ing within a specific discourse community. In the same vein, “society-focused” kairos can be

more encompassing than an individual one; this is why rhetors must be ready to analyze any situ-

ation from every possible angle and determine which variables offer the best opportunities for

productive arguments to deploy and defend (Glasshoff 10, 11). As the kairotic moment evolves,

both audience and rhetor jointly participate to create a rhetorical invention—in this fashion, all

possible arguments can be discussed, defended, or discarded (Crowley and Hawhee 43; Glass-

hoff 12).

An important application of kairos as a means of invention is understanding the rhetoric

of science. Michael Ruse expounds that “A scientist producing a piece of work wants to con-

vince his or her readers of the truth of the work and its significance in the overall scheme of

things” (244). If the “scientist” in the preceding quote is replaced with another term such as

“doctor,” “nurse,” or “public health professional,” the same aims of persuasion would be used.

This means that clinicians may follow certain conventions for informing, recording, and report-

ing specific health conditions and report those findings through specific academic conventions

such as plain language, active and passive voice, and even fonts. However, kairos can allow cli-

nicians to adjust their message to specific audiences, whether it comes from individual patients,

families, academic panels, or government hearings. The dissemination of rhetorical information

is not static; rather, the kairotic situation between the scientific and public communities and their

reception could determine what new forms of science could be seen as “wondrous” or innovative
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against what could be considered “mundane” (Glasshoff 27). That being said, new ideas for dis-

semination must be well researched and defended, or they risk being disregarded in an environ-

ment “hostile to new ideas” (21).

Crowley and Hawhee use a five-point exploratory that serves as guidelines for temporal

and spatial discussions of kairos, which allows rhetors to prepare their arguments and manage

rebuttals more effectively. Briefly summarized, the following questions are (44):

• Have recent events made the issue urgent, or how can they be relevant today? (Urgency

and Immediacy)

• What arguments are favored by specific groups, and how are their interests served? (Ar-

guments and Interests)

• How do shifting power dynamics reflect the positions within the argument? (Power Dy-

namics)

• What lines of argument would be appropriate or inappropriate based on the needs of the

audience? (Appropriateness)

• What other issues are bound with the discourse? (Additional Issues)

It is important to note that these questions are heuristics that can change based on the competing

values and interests of the specific parties. For this reason, Janice M. Lauer notes that heuristic

thinking is flexible and “work[s] in tandem with intuition, prompt[s] conscious activity, and

guide[s] the creative act but never determine[s] the outcome” (8). Heuristics allows the rhetor

with enough flexibility to engage with competing arguments, as well as donning knowledge of

the issue (Crowley and Hawhee 43).

What is Gender-Affirming Care?

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Keuroglian et al defines the term gender-affirming care as “the provision of health ser-

vices to support a person’s process of living and being perceived in alignment with their own

gender identity and expression” (2464, emphasis mine). It is important to clarify two concepts

highlighted in the previous sentence: gender identity, which refers to a person’s sense of self as

being male, female, or elsewhere within or outside the confines of the gender binary (American

psychological Association 20, 21); and gender expression, which focuses on an individual’s

“presentation […] and behavior that communicates aspects of gender or gender rule” that need

not confine to the individual’s identity (20). Any perceived disconnect or discomfort between

one’s gender identity and sex assigned at birth may cause gender dysphoria, which must be

treated with “inclusive and culturally responsive environments,” as well as support in legislation

that protects trans and gender diverse (TGD) population (Keuroglian et al 2464; American Psy-

chological Association 20). This medical approach has also been described as the “depathologi-

sation” of TGD people, treating gender as an identity that must be protected instead of a disorder

that must be treated or cured (de Vries et al 2). Gender-affirming measures can include psycho-

logical acceptance; social transitioning; non-medical strategies like binding or genital padding;

medical or hormonal affirmation such as taking estrogen or progesterone; and surgery (Keurog-

lian et al 2464). All procedures include an understanding of informed consent with patients—in-

cluding parents if patients are minors—, doctors, and other healthcare providers (“HRC Ex-

plains”).

There is extensive research noted by de Vries et al surrounding the adverse outcomes for

TGD women in medical settings. Major findings include: 63% of TGD women suffer from de-

pression in the United States due to external factors such as “stigma, prejudice, and discrimina-

tion” (Strauss et al, qtd. in de Vries et al 4); are at significant risk of acquiring HIV and other
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sexually transmitted infections (4); have experienced physical and sexual violence and harass-

ment (4); are more likely to experience stigma and discrimination within their family unites (5);

and have expressed “cisnormative microaggressions” from the medical establishment that point

out to a lack of understanding of the perceived abnormality of their life experiences (5). In addi-

tion, since 2020 states such as South Dakota, Alabama, and Arizona have passed a series of laws

criminalizing and/or restricting gender-affirming care, with punishments ranging from misde-

meanors to felonies (Abreu et al 644); as such, parental figures of TGD children have mentioned

in a 2021 study that the latter have experienced significant psychological distress such as “in-

creased suicidality, depression, anxiety, and gender dysphoria” (649). Moreover, the regulations

banning sex discrimination under the Affordable Care Act (ACA) have significantly diverged

within the last three presidential administrations, compounding the stress and confusion experi-

enced by both patients and medical providers—in the case of the latter, “in complying with a

state ban on providing gender-affirming care, they would be violating federal antidiscrimination

law” (Lane et al 1917).

Conversely, a report from the U.S. Department of Health’s Office of Population Affairs

indicates that gender-affirming care can “yield lower rates of adverse mental health outcomes,

build self-esteem, and improve overall quality of life for [TGD] youth” (Office of Population Af-

fairs 1); this means that, even if a youth does not complete the course of treatment as suggested,

gender-affirming care can provide a reduction of symptoms and affords a greater and safer ex-

ploration of one’s gender identity. Also, a 2021 systematic review found that “parent connected-

ness” increases resilience among TGD teens and young adults, as well as providing a safe space

for exploration (Boerner 2022). Access to hormone therapy for teenagers reported a 60% reduc-

tion in suicidality in early adolescence and 50% in early and late adolescence; a 60% reduction
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of severe depression for those with access to puberty blockers; and a 73% reduction in self-harm

and suicidality for those with access to medical treatment (Boerner 2022). As discussed by pedi-

atrician Jane Chang, M.D., “Gender-affirming care, at its most basic level, is about validating

and supporting children and loving them for who they are as they explore their identity” (Woo

2022).

Urgency and Immediacy

As Crowley and Hawhee point out, “Kairos is fickle, and as is suggested by his winged

shoes, he is also fleeting” (44). The urgency of a rhetorical situation depends on the level of ac-

tivity surrounding it. This can include controversial topics such as abortion and gun rights, whose

discussion has grown polarized over the years and are always considered urgent topics in Ameri-

can culture. On the other hand, Crosby explains that kairos can be manufactured as part of a rhe-

torical agenda which can represent “an unfolding series of events” (Crosby 137); this means that

controversial topics can disappear from public discourse, only to erupt once again when a sudden

event or tragedy like a mass shooting for gun violence or the overturning of Roe v. Wade for

abortion unfolds.

Regarding gender-affirming care, its urgency is playing out across state legislators, treat-

ment centers, and communities with discussions surrounding everything but the science of medi-

cal procedure and its effects. Reporter Andrew DeMillo notes that the rhetoric “further exacer-

bates an already treacherous environment for transgender people, their families, and medical pro-

viders” through elements such as coercion and humiliation in public hearings that dehumanize

the person and reduces them into a single body part, further endangering their safety (2023). Ele-

ments of urgency include harassment to gender-affirming care providers, such as phone calls,

death threats, physical assault or even bomb threats to force providers into halting services out of
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fear of their own safety (Llant 2023). In addition, the controversy surrounding this type of care

ties into the growth of extremist rhetoric as a justification to create more stringent legislation or

submission, a phenomenon coined as stochastic terrorism, where “hate speech increases the like-

lihood that people will attack the targets of vicious claims” (Santoro 2022). When such rhetoric

threatens scientific integrity—and people’s lives—the urgency of a topic is significantly ampli-

fied, even if the violence is not physical.

Arguments and Interests

Crowley and Hawhee define interest as “the reason or reasons why someone takes a

given position on an issue” (353). Different motives underpin why rhetors and/or discourse com-

munities disagree on a topic. For instance, there could be financial considerations. There is also

an awareness to inform and advise the audience of unethical business or medical practices. There

can also be political goals, to get elected or raise money for a political campaign. Whatever the

motive is, the arguments and interests of a community are shifting and must be considered when

analyzing kairos. Rhetors can use these considerations to frame an argument for a specific dis-

course community with greater success (45).

A contentious point in the gender-affirming care debate involves detransitioning, which

involves “stopping or reversing gender transition,” considered rare or statistically insignificant

occurrence in medical literature (Tanner 2023). Quantifying the rate of detransitioners is difficult

because they may stop taking gender-affirming hormones or see new physicians or specialists

who may have not treated them in the first place. Regret is also a complicated measure to quan-

tify because, for teenagers who choose to detransition, it affords an opportunity for self-discov-

ery (Tanner). Likewise, patients may choose to end therapies because they feel comfortable with

any bodily changes or feel unsatisfied with any side effects (Respault et al 2022). Even
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professional bodies such as the World Professional Association for Transgender Health

(WPATH) or the Endocrine Society does not have treatment guidelines for clinicians attending

detransitioning patients. However, detransitioners—as well as trans people—have found the ex-

perience to be “isolating” and having lacked support from the providers and the community who

may have judged or misunderstood their motives for transitioning in the first place (Respault et

al).

Given the ongoing controversy surrounding detransitioning, the previous paragraph ex-

emplifies the various arguments and interests surrounding the discourse. Doctors, physicians, and

researchers are hesitant to investigate detransitioning because the occurrences are rare and may

or may not be motivated by regret—notwithstanding the threats received for continuing to pro-

vide gender-affirming care. Alternatively, they are unaware of any guidelines mentioning the

best practices for detransitioners. Gender-affirming care opponents might “weaponize rare

causes of detransition in their efforts to limit or end it altogether,” as is occurring throughout the

country (Respault et al 2022). They may reason that gender is not flexible nor a construct and at-

tempts to change it are futile. Transgender patients may feel that detransitionesrs invalidate their

ongoing struggle for visibility, while detransitioners are left without major guidance on navi-

gating the complexities of gender identity, at the same time facing bullying or harassment from

other groups—including trans people. As Crowley and Hawhee note, “Most issues that capture

our attention are highly complex, and they resonate differently among groups with differing po-

litical or social agendas” (45). This way, kairos attempts to seize the opportunities provided by

each discourse community.

Power Dynamics
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Crowley and Hawhee argue that a proper inventive to engage in kairos is “to consider the

power dynamics at work in a particular issue” (50). Likewise, the growth and advancement of

science embraces more details that provide a “complete and more effective” (and oftentimes nu-

anced) exploration of our social dynamics (Miller 314, 315). However, who disseminates (or fi-

nances) knowledge could be as, or more effective, than what knowledge is being disseminated.

For this reason, the goal of kairos is to seize the moment and choose the most important argu-

ments that will draw attention and engagement to their rhetoric. Power is subjective, but also

fleeting and persuasive. In the case of gender-affirming care, lawmakers and doctors are on op-

posing sides of the debate, but are considered to hold greater authority than trans and LGBTQ+

youth unless they are involved in larger (and better funded) advocacy groups. This also provides

a discussion on the differing power dynamics inherent through situated ethos; however, it is im-

portant to note that “Few rhetors enjoy absolute power over either hearers or readers” and, re-

gardless of political persuasion, they must engage with audiences to better deliver their message

(Crowley and Hawhee 162).

Journalist Rex Huppke penned an opinion piece on USA Today where he questions politi-

cians for ignoring the science in creating the anti-trans laws, while questioning their true mo-

tives:

I want you to search your soul, or whatever inhabits the space where your soul once
resided, and defend the decision to aggressively attack an already vulnerable group
of people for … for what? For political gain? For clicks? So you don’t have to
expend the small amount of intellectual energy it takes to understand an issue that,
for whatever reason, makes you uncomfortable? (Huppke 2023)

In this passage, Huppke theorizes various reasons politicians are colluding against the trans com-

munity through legislation: first, for political engagement; second, for attention; and third, due to

discomfort over the changing trends of sex, race, and gender in the United States.
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Acknowledging that, for instance, “Gender is a social construct,” can change across one person’s

lifetime, and can exist in a spectrum could be unfathomable for conservative politicians, as well

as their voters who have stringent and rigid views on sex and gender (Bhatt et al 31). The author

also issues an explicit condemnation through the rhetorical use of “You” alongside its aggressive

tone and direct challenges to the politicians’ situated authority. In addition, the author addresses

the arguments and interests of lawmakers into clinging themselves to power. However, this pas-

sage is subversive to typical power dynamics: whereas reporters typically request politicians for

statements, Huppke demands them to think about their careless actions without a guarantee to

respond.

Organizations like the American Academy of Pediatrics, the American Psychological As-

sociation, and the American Medical Association support the practice of gender-affirming care.

Pediatrician Jane Chang, M.D., notes that “Gender-affirming care is evidence-based and done in

a developmentally appropriate manner as we give patients and families the space to express the

youth’s individual gender experience and journey” (Woo 2022, emphasis mine). It is noteworthy

that Chang emphasizes on the treatment being proven by scientific and empirical methods, and

takes into consideration the patient’s needs while advising that one’s vision of gender may

change during treatment, potentially rendering treatment (as in the case of many detransitioners)

illuminating, yet moot. Bhatt et al argue that, for medical practitioners, “Providers also hold sig-

nificant power of advocacy and can help patients from both an individual and systemic level”

(31); in other words, medical providers have the power and authenticity to become advocates for

TGD patients, more so when they can use their platform to provide inclusive care and effect pol-

icy changes towards the community (30).

Appropriateness
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Crowley and Hawhee note that “appropriateness [in kairos] is indicated by the standards

of the community in which we live” (254). This means that what is appropriate in one situation

may not be appropriate in other contexts. Whether the wording used in a speech is formal or the

metaphors and enargeia in a description amount to hyperbole reflect on the quality of the kair-

otic argument, as well as the rhetor’s stylistic choices and how aware he or she is to the needs of

the community. Crosby argues that “the spatial kairos marks an attempt to capture and sustain

the transcendent meaning of a revelatory moment” (139, emphasis mine)—and a proper under-

standing of spatial dynamics, whether it be a school, church, doctor’s office, or statehouse, style

and decorum play a significant part in maximizing the rhetor’s message and delivery. What type

of discourse is appropriate or not is also a subjective measure that may or may not be defined

through one’s own worldview.

Returning to Huppke’s opinion piece surrounding politicians’ underhanded comments to-

wards perpetuating anti-trans discrimination, he uses a plain style of writing, where “clarity is the

main goal dictated by the occasion,” instead of the middle style that uses “leisurely” arguments

and enjoins many commonplaces (Crowley and Hawhee 255, 56). The author also engages in

rhetorical questions that imply is already stated through the authors’ intent (255). As previously

mentioned, Huppke does not treat the subjects of his opinion piece with the deference and deco-

rum expected by politicians—rather, he treats them with scorn and contempt, an inappropriate

way to address the issue. Along with kairos, Huppke demonstrates his anger and disappointment

through a mixture of plain and primer styles; for the latter, Jones argues that, while its choppy

sentence structure feels coherent and “difficult to read,” the style can be used to address readers

with “poor reading skills and limited comprehension” (47, 48). Huppke is not a medical
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practitioner, but he implicitly confronts opposing lawmakers’ attempts to ignore the discussion

of gender for personal gain.

Additional Issues

The complexity of rhetorical issues also affects the quality of the arguments provided by

the rhetor. It is important, then, to “be aware of the issue’s ever-shifting nuances, which might

lead to new opportunities for rhetorical argument” (Crowley and Hawhee 51). While considering

through every major detail surrounding a topic, rhetors should be encouraged to analyze the

stakes and impact to craft a response. Brett Zimmerman concurs that restricting gender-affirming

care is a form of violence that ultimately flies in the face of “social cohesion instrumental to

peaceful democracy” (152). He also ties the values displayed on the January 6, 2021 insurrection

of the US Capitol to the lopsided values of “bodily autonomy via [COVID-19] mask mandates,”

at the same time hypocritically conspiring to take away others’ autonomy through “a sense of en-

titlement” (153). Moreover, he ties the ongoing struggles for gender-affirming care to a statistic

that only 54% of LGBTQ+ citizens live in states that protect their gender identity from hate

crime laws, or that 16 states banned “gay/trans panic” legal defenses (152). Violence against

trans, queer or Americans of color is an affront to the nuances of public health, our democracy,

our social cohesion, and the dignity of human life:

In the face of growing structural violence, concern over dignity may seem meek.
But honoring dignity is not nothing. In fact, it could be everything. Allowing some-
one their full self in turn allows us our full selves. We dignify ourselves when we
dignify others. (153)

To accept the usefulness of gender-affirming care is to realize that gender is or has never

been a clear-cut source of identity; that the binary is only an imaginary construct meant to gate-

keep what society considers “normal” and what it does not; that the ongoing attempts to restrict

gender-affirming care under the guise of “protecting the children” only amounts to the
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normalization of bullying, persecution, and violence against an already marginalized community.

The ongoing situation is repressive and regressive, denying the dignity of trans and queer Ameri-

cans to live their authentic selves. Analyzing the kairos of gender-affirming care is not only a

way to analyze the opportunities that provide the best rhetorical impact; it also attempts to de-

mystify and provide acceptance to the broader LGBTQ+ community. Seizing the opportunity to

engage in a controversial topic is a salient and valuable decision for rhetors to partake in if this

will improve the quality of the debate and afford new avenues for communication. Kairos is in-

tersectional, to which a wealth of possibilities that open further rhetorical analyses. This can also

open the opportunity to foster unity and engage with acceptance.

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