Somewhere in the fluorescent theater of congressional outrage, Congressman Brandon Gill apparently found himself face-to-face with one of the most dangerous forces in American politics: a grant title he did not understand. The phrase in question was “teen pregnancy prevention for transgender boys,” and judging from the performance, Gill treated those words as if someone had dragged a haunted Ouija board into the hearing room and asked taxpayers to fund demon yoga. He seemed to believe that if he said the phrase with enough theatrical disbelief, the whole country would gasp, clutch pearls, and forget how bodies work.

That was the plan, at least. The problem is that reproductive anatomy entered the room wearing steel-toed boots and carrying receipts. “Pregnancy prevention for transgender boys” is not a contradiction. It is not a mystical riddle. It is not some secret government plot to confuse your uncle at Thanksgiving until he starts yelling about pronouns into the mashed potatoes. It is a medically coherent phrase that refers to youth who were assigned female at birth and identify as transgender, including trans boys and nonbinary youth, some of whom may still have reproductive anatomy that allows pregnancy.

That is the part Gill either missed, ignored, or decided was too inconvenient for the little anti-woke puppet show he was trying to stage. Transgender boys are boys. Many transgender boys were assigned female at birth. Some still have a uterus, ovaries, fallopian tubes, and a cervix. Some ovulate. Some have sex involving sperm exposure. Some may become pregnant. None of this requires a doctoral degree, a white coat, or a secret decoder ring from the Department of Common Sense. It requires the ability to distinguish gender identity from reproductive anatomy, which apparently now counts as advanced placement biology in certain congressional districts.

The federal project Gill mocked was not claiming that cisgender boys can become pregnant. It was not suggesting that masculinity produces fallopian tubes through vibes. It was not asking America to suspend biology. The grant description identified youth assigned female at birth who identify as transgender, including trans boys and nonbinary youth, and sought to adapt an existing teen-pregnancy prevention program for young people who are often missed by programs written as if every person at risk of pregnancy identifies as a girl or woman (National Institutes of Health, 2024). That is not ideological sorcery. That is public health recognizing that real people exist outside the cardboard cutouts politicians use for campaign content.

Gill wanted a punchline. He became one.

The Joke Was Supposed to Be on Trans People. It Landed on the Congressman.

The whole trick behind this kind of hearing-room performance is that the politician expects the audience to react before thinking. Say “pregnancy prevention for transgender boys” with the right smirk, then wait for the outrage machine to do the laundry. The phrase is supposed to sound ridiculous enough that nobody asks what it actually means. It is rhetorical fast food: cheap, salty, and nutritionally bankrupt.

Gill appeared to be banking on the idea that “boy” and “pregnancy” cannot occupy the same sentence unless civilization has collapsed. That may work in a campaign clip edited for people who believe biology stopped updating after a 1987 abstinence pamphlet. It does not survive contact with actual health care. A transgender boy may be male in identity and still have organs associated with pregnancy. A nonbinary teen assigned female at birth may reject girlhood and still need information about condoms, contraception, fertility, sexually transmitted infections, and sexual consent. A program can recognize gender without pretending anatomy dissolved into mist.

That is the part these performances never want to sit with. Anti-trans politicians love to shout “biology” until biology stops helping them. Then they shove biology under the podium and start yelling about “woke.” They invoke science as a mascot, not as a discipline. The second science says something inconvenient, such as “testosterone is not birth control” or “some transmasculine youth can become pregnant,” the same people who were just waving the biology flag suddenly act like medical reality was planted by George Soros in a lab coat.

The congressman did not discover a scandal. He discovered his own assumptions. Then he held them up like evidence. That is not oversight. That is a man bringing a kazoo to a fire alarm and expecting applause for public safety.

The grant title did exactly what a public-health title should do. It named the population. It named the intervention. It named the goal. The fact that Gill could not process the title without turning it into a culture-war carnival act says more about the quality of the outrage than the quality of the research. If a lawmaker cannot understand why someone assigned female at birth might need pregnancy prevention after identifying as a boy, the problem is not the grant. The problem is that Congress keeps letting people cosplay as experts after they fail the opening vocabulary quiz.

Testosterone Is Medicine, Not a Force Field Around the Uterus

One of the laziest myths in this conversation is the belief that testosterone automatically eliminates pregnancy risk. It does not. Testosterone may stop periods for many transmasculine people. It may reduce fertility. It may change libido, body hair, voice, fat distribution, muscle mass, and a long list of other physical features. None of that makes it a contraceptive method.

UCSF Transgender Care states that testosterone may reduce the ability to become pregnant, yet it does not completely eliminate pregnancy risk. Their guidance plainly says that transgender men can become pregnant while taking testosterone and should use birth control if they remain sexually active with someone capable of producing sperm and do not want pregnancy (UCSF Transgender Care, n.d.-a). That is not activist folklore. That is clinical guidance from a major academic medical program. It is written with the kind of clarity Congress might benefit from, assuming anyone there is still willing to read past a headline.

Apparently, someone needs to inform Capitol Hill that hormones are not force fields. Testosterone does not stand outside the uterus with sunglasses and an earpiece telling sperm, “You are not on the guest list.” It does not function like a bouncer at the club of reproductive risk. It does not turn contraception into a decorative hobby. If a person has the relevant anatomy and engages in sexual activity that can result in pregnancy, pregnancy prevention remains medically relevant.

This is where the satire writes itself, then files for hazard pay. The same crowd that claims to worship biology suddenly cannot follow the path from sperm to egg if a transgender person is involved. They can recite “male and female” like a malfunctioning toy at a yard sale, yet the minute a trans boy enters the conversation, they forget that people assigned female at birth may retain the organs involved in pregnancy. The map did not change. Their willingness to read it did.

Public health cannot afford that level of deliberate confusion. Teens need accurate information. Trans teens need accurate information. Teens on testosterone need accurate information. Teens who do not get periods may assume they cannot get pregnant. Teens who receive sex education that only speaks to “girls” may mentally check out if they do not identify as girls. That gap is not theoretical. It is exactly the sort of gap pregnancy-prevention programs are meant to address.

A serious lawmaker would ask whether the program works. A serious lawmaker would ask how outcomes are measured, how youth are protected, what evidence supports the intervention, and how the cost compares with preventable teen pregnancy, untreated sexually transmitted infections, and health-care avoidance. Gill chose the cheaper route. He pointed at the phrase, made it sound spooky, and waited for the audience to confuse mockery with math.

The “Final Surgery” Myth Needs to Be Thrown Into the Political Wood Chipper

Part of the confusion around this issue comes from the fantasy that every transgender person follows one standardized checklist, ending with some grand “final surgery” that magically resolves every medical, social, legal, sexual, and reproductive question forever. That is not how transition works. There is no universal “Congratulations, you have completed transgender” certificate issued by the Department of Gender. There is no final boss battle where someone defeats dysphoria with a sword and receives a new anatomy file from the federal government.

Transition is deeply individual. Some people socially transition. Some use hormones. Some pursue surgery. Some do not. Some want surgery but cannot afford it. Some are blocked by insurance. Some are blocked by state law, family pressure, geography, disability, health risks, or the plain fact that American health care often behaves like a locked door with a billing department attached. Some trans men and trans boys may later have hysterectomies, oophorectomies, salpingectomies, or other procedures. Some retain a uterus and ovaries for life.

That variation is exactly why pregnancy-prevention language has to be accurate. A trans boy who still has a uterus and ovaries may be able to become pregnant. Removal of the uterus prevents carrying a pregnancy. Removal of both ovaries ends ovulation. Removal of fallopian tubes changes the route for egg and sperm interaction, though medical circumstances can vary, and assisted reproduction questions may differ depending on which organs remain. The point is not that every trans boy has the same risk. The point is that risk depends on anatomy, sexual behavior, fertility, and contraception, not on whether a congressman can make a smirk land on camera.

This is where Gill’s performance gets especially irritating. He framed the issue as if the words themselves were absurd, yet the absurdity came from his own cartoon version of transgender health. He seemed to be arguing against a fantasy policy where the government believes all boys can become pregnant. That is not the policy. That is not the grant. That is not the science. That is the straw man he dragged into the hearing room, dressed up in a bad wig, and beat with a rolled-up press release.

The actual claim is narrow, factual, and unremarkable to anyone who knows anything about reproductive health: some transgender boys and AFAB nonbinary youth can become pregnant. They may need pregnancy-prevention information that speaks to them accurately. Programs that erase them can miss them. Programs that speak only to “girls” may fail young people who do not identify that way but still carry pregnancy risk. That is not radical. That is competence.

Public Health Has to Reach Real People, Not the Imaginary People Politicians Prefer

Public health fails when it talks past the people it claims to serve. A pregnancy-prevention program written entirely around girls may reach many cisgender girls well. It may still fail a trans boy who hears “girls” and assumes the information is not meant for him. It may fail a nonbinary teen assigned female at birth who has never seen their body, identity, and sexual health needs discussed with any respect. It may fail the very young people who already face higher barriers to care, lower trust in institutions, and more reasons to avoid a clinic until a problem has become a crisis.

That is not political fluff. It is communication. A message has to find the person who needs it. If the message cannot name the person, the person may never receive the message. That is not a hard concept unless one is determined to turn inclusion into a bonfire for fundraising emails.

Picture a trans boy who started testosterone six months ago. His periods stopped. Nobody told him that pregnancy is still possible under certain conditions. His school sex-ed class talked about girls getting pregnant, and he tuned out since the language felt like it belonged to someone else. He is not stupid. He is underserved. He is living in the gap between a body that can still carry reproductive risk and a public system too frightened of controversy to speak clearly.

Picture a nonbinary teen assigned female at birth who has sex with a boyfriend, a girlfriend, or someone whose body can produce sperm. Standard sex education may have treated their identity as nonexistent. LGBTQ youth programming may have focused on stigma and mental health without enough practical reproductive content. A gender-inclusive pregnancy-prevention program can address condoms, birth control, emergency contraception, consent, STI prevention, dysphoria, trauma-informed care, and how to talk to clinicians without being humiliated. That is not decadence. That is prevention.

Picture a health educator trying to reach teenagers who have already learned that adults turn their lives into jokes. The educator has to say, with a straight face and a steady heart, “Your body deserves accurate information. Your identity does not disqualify you from care. You do not have to misgender yourself to learn how pregnancy works.” That is the work Gill reduced to a sneer. That is the work his little performance tried to flatten into a meme.

Public health is not improved by pretending vulnerable youth vanish when politicians become uncomfortable. It is improved by speaking plainly enough that risk can be reduced. It is improved by accuracy. It is improved by trust. It is improved by meeting young people where they actually are, not where Brandon Gill’s donors might prefer them to be for a 30-second clip.

The Research Gill Mocked Was Doing the Work He Would Rather Ridicule

The NIH project that became Gill’s chosen prop was not a random pile of rainbow confetti with a grant number attached. It was connected to adapting Girl2Girl, a text-message-based teen-pregnancy prevention program originally designed for cisgender sexual-minority girls, to make it gender-inclusive for AFAB trans-identified youth (National Institutes of Health, 2024). The NIH abstract identifies social stressors, discrimination, dysphoria, and rejection as influences that may shape sexual behavior and health engagement among the youth the adapted program seeks to reach (National Institutes of Health, 2024).

That is exactly the kind of adaptation competent public health often requires. A program can work for one group and still need revision for another. That is not scandalous. It is the entire logic of applied research. We adapt cancer screenings, HIV prevention, diabetes education, mental-health outreach, smoking cessation, substance-use treatment, and domestic-violence services for different populations all the time. Nobody thinks it is strange until transgender youth enter the sentence and the culture-war ambulance chasers start chasing sirens they created themselves.

USAspending lists the grant as “#TranscendentHealth – Adapting an LGB+ inclusive teen pregnancy prevention program for transgender boys,” with the recipient identified as the Center for Innovative Public Health Research and an obligated amount of $1,319,024 (USAspending.gov, n.d.). That is public information. It is fair to review the cost. It is fair to ask what outcomes the research is pursuing. It is fair to ask whether the intervention can reduce unintended pregnancy risk, improve contraceptive knowledge, increase condom use, or improve health-care engagement.

What is not fair is pretending the basic premise is absurd when the premise is medically obvious. If Gill wanted to ask whether the grant was efficient, he could have done that. If he wanted to ask whether the research design was strong, he could have done that. If he wanted to compare the cost of prevention with the public cost of teen pregnancy and untreated sexual-health needs, he could have done that too. He did not take that route. He went for the cheap laugh, then expected the public to call it oversight.

That is the central fraud of this style of politics. It dresses mockery up as fiscal responsibility. It points at a marginalized population, says the name with a curled lip, and invites the audience to confuse disgust with evidence. It does not care whether the program works. It does not care whether youth are helped. It does not care whether the medical claim is correct. It needs the target to sound strange enough that the crowd stops asking questions.

The tragedy is that some people will. The responsibility is that the rest of us refuse.

The Data Did Not Ask Gill for Permission to Exist

The research base on transgender boys, AFAB nonbinary youth, and pregnancy risk is still developing, which is one reason targeted research exists in the first place. A 2025 study in JAMA Pediatrics examined sexual-health indicators among cisgender girls, transgender boys, and AFAB nonbinary youth. The study found that rates of penile-vaginal sex were similar for transgender boys and AFAB nonbinary youth compared with cisgender girls, a finding that directly undercuts the lazy assumption that pregnancy-prevention concerns for these youth are imaginary (Ybarra et al., 2025).

That finding should have ended the circus. If trans boys and AFAB nonbinary youth report sexual behaviors that can create pregnancy risk at rates comparable to cisgender girls, then pregnancy-prevention programming is not some fever dream from the “woke” basement. It is a response to actual behavior among actual youth. Identity does not erase the biological pathway for pregnancy. Silence does not reduce risk. Mockery does not prevent conception. A congressional sound bite does not count as contraception, no matter how hard the congressman tries to make it reproduce online.

The study’s broader lesson is simple: public health has to study the people politics prefers to caricature. If the evidence shows risk, responsible systems respond to that risk. If the evidence shows gaps in knowledge or access, responsible systems address those gaps. If youth are being missed by programs built around older assumptions, responsible systems update the programs. This is what grown-up governance looks like when it is not being dragged through the mud by people auditioning for cable-news dopamine.

Gill’s posture depends on the audience not knowing the data. It depends on people hearing “transgender boys” and assuming impossibility. It depends on the public forgetting that “assigned female at birth” is not a decorative phrase. It identifies a medical history that may carry reproductive implications. A trans boy who still ovulates and has sex involving sperm exposure can face pregnancy risk. That sentence is neither complicated nor controversial in a medical setting. It only becomes explosive in politics, where ignorance is often treated as a regional dialect.

The study did not ask Gill to approve of transgender youth. It did not ask him to understand gender identity at a soul level. It presented evidence about sexual-health indicators. That should be enough for a policy conversation. The standard should not be whether the congressman can personally metabolize the existence of trans kids without turning into a talk-radio foghorn. The standard should be whether public programs are accurate, evidence-informed, and able to reduce harm.

“Taxpayer Waste” Is a Convenient Costume for Anti-Trans Panic

Let us talk about the money, since that is the costume this outrage wore to the party. Public grants should be reviewed. Taxpayers deserve transparency. Research should have measurable goals, ethical safeguards, and accountability. Nobody serious should object to those principles. The problem is that Gill’s performance did not sound like a serious audit. It sounded like someone found the word “transgender” in a federal database and started ringing the town bell.

That distinction matters. There is a meaningful difference between “Does this program demonstrate value?” and “Can you believe transgender boys were mentioned in public health research?” The former is oversight. The latter is a cheap culture-war stunt with a committee microphone. Oversight asks for evidence. Stunts ask for a reaction. Oversight looks at design, population, outcomes, cost, ethics, and need. Stunts look at the title and start making faces.

If Congress wants to talk about waste, fine. Let us talk about the cost of performative ignorance. Let us talk about what happens when lawmakers spread confusion about contraception, testosterone, and pregnancy risk. Let us talk about the public cost of teen pregnancy, delayed care, untreated infections, mental-health harms, and medical avoidance among youth who already face stigma. Let us talk about the price tag attached to policies that push trans young people out of clinics, out of schools, out of care, and into silence.

The taxpayers did not fund the confusion here. Gill brought that from home.

A grant aimed at pregnancy prevention is, by definition, an attempt to reduce future harm and cost. If it works, the public benefit may include fewer unintended pregnancies, better contraceptive knowledge, safer sexual behavior, and improved trust between marginalized youth and health systems. Those outcomes are worth evaluating. They are not worth laughing out of the room. Only a politics addicted to cruelty would look at teenagers who might need accurate reproductive-health information and decide the real emergency is that the grant title annoys the base.

This is the part that should make people furious. Gill did not merely misunderstand a phrase. He turned a real health issue into a prop. He invited the public to laugh at the idea that trans boys might need pregnancy prevention. That laughter lands on real kids. It lands on the trans boy who cannot ask a doctor a question without bracing for humiliation. It lands on the nonbinary teen who does not know whether emergency contraception applies to them. It lands on the young person who has been told from every direction that their body is a political battleground instead of a body.

If Gill Were Serious, He Could Have Asked Serious Questions

A responsible lawmaker had several available paths. Gill could have asked what the program’s measurable outcomes were. He could have asked how researchers planned to assess contraceptive knowledge, condom use, pregnancy-risk awareness, birth-control access, STI prevention, and health-care engagement. He could have asked what protections were in place for youth privacy and consent. He could have asked how the program handles trauma, dysphoria, family safety, and clinical referrals.

He could have asked whether the adapted intervention would be compared against existing programming. He could have asked whether the original Girl2Girl program produced results that justified adaptation. He could have asked how the grant budget was structured. He could have asked whether the study would produce scalable tools for clinics, schools, or community health providers. He could have asked whether the program would help youth who are overlooked by standard sex education. Any of those questions would have signaled genuine oversight.

Instead, he went with the intellectual equivalent of slipping on a banana peel, then accusing the floor of Marxism.

That is what makes the performance so revealing. The issue was never really fiscal discipline. The issue was the political usefulness of confusion. “Pregnancy prevention for transgender boys” sounds strange only to people who refuse the basic explanation. Once explained, it becomes almost boring. Some boys are trans. Some trans boys were assigned female at birth. Some retain anatomy that can make pregnancy possible. Some need prevention. Public-health programs should reach them. End of mystery.

The anti-trans movement cannot afford that clarity. It needs the public stuck at the phrase, not the facts. It needs citizens laughing before learning. It needs the word “transgender” to function like a smoke bomb, filling the room with panic so nobody notices the policy question underneath. Gill played his part with impressive confidence, the way a man might confidently enter a spelling bee holding a calculator.

There is room for hard questions about federal spending. There is room for debate about research priorities. There is room for examining whether any grant, from any administration, meets public-interest standards. There is no room for pretending that a population’s existence is itself a punchline. There is no room for substituting theatrical confusion for knowledge. There is no room for using trans youth as kindling in another taxpayer-funded outrage fire.

The Human Cost Is the Part the Punchline Tries to Hide

It is easy to make a joke out of people when you never intend to meet them. That is the hidden cruelty in Gill’s performance. The young people at the center of this issue are not abstractions. They are not grant-title decorations. They are not props in a congressional morality play. They are teenagers trying to understand their bodies under political conditions that keep telling them their existence is up for debate.

Some of them are trying to survive school hallways where every policy fight becomes another reason for classmates to mock them. Some are trying to get basic health care without being misgendered, interrogated, or treated like a problem to be solved. Some are trying to reconcile dysphoria with the practical needs of reproductive health. Some need contraception but feel intense distress about seeking it, since the whole process may force them into language and environments that deny who they are. Some need adults to stop treating accuracy as surrender.

That is what Gill flattened into comedy. He took a real public-health issue and presented it as ridiculous. He gave permission to everyone watching to do the same. That is not harmless. Political mockery travels. It moves from committee rooms to social media feeds, then into school boards, clinics, living rooms, classrooms, church basements, and state legislatures. By the time it reaches a trans kid, it has hardened into policy, stigma, and fear.

The cruelty is not just that he laughed. The cruelty is that the laugh requires pretending real youth are imaginary. It requires pretending a trans boy with a uterus cannot exist. It requires pretending that a young person’s need for pregnancy-prevention information becomes absurd once he identifies as male. It requires pretending that public health should serve only the people who make conservative politicians comfortable.

A decent society does not build health policy out of discomfort. It builds health policy out of evidence, ethics, and care. It asks who is at risk. It asks who is being missed. It asks what information prevents harm. It asks how to speak to people in language they can hear. It does not point at teenagers and perform ignorance for applause.

Anatomy Remains Undefeated

Brandon Gill tried to make “pregnancy prevention for transgender boys” sound like proof that the government had lost its mind. Instead, the phrase revealed that his outrage depended on not understanding the issue. The medical facts are plain. Some transgender boys and AFAB nonbinary youth can become pregnant. Testosterone is not reliable contraception. Programs that speak only to girls may miss youth who do not identify as girls but still have pregnancy risk. Research that adapts prevention tools for those youth is not inherently absurd. It is exactly the kind of work public health does when it bothers to count people who have been erased.

That does not mean every grant is automatically good. It does not mean public funding should never face scrutiny. It does not mean researchers should get blank checks. It means the first step in oversight is understanding what one is overseeing. If a congressman cannot clear that bar, he should put down the microphone and pick up a pamphlet.

The real scandal here is not that someone funded research involving transgender boys and pregnancy prevention. The scandal is that a member of Congress thought mocking the phrase counted as analysis. The scandal is that trans youth are so politically disposable to some people that their health needs can be turned into a punchline before the facts are permitted to speak. The scandal is that the loudest people yelling “biology” keep fainting at the sight of actual biology.

Gill wanted to embarrass the grant. He embarrassed himself. He swung at public health and hit his own credibility in the face. He marched into battle against reproductive anatomy armed with a smirk, a talking point, and the confidence of a man who has never met a complex issue he could not flatten into bait.

Pregnancy prevention for transgender boys is not nonsense. It is not anti-science. It is not proof that the country has gone mad. It is proof that bodies are real, gender is real, risk is real, and prevention has to reach the people who need it. Brandon Gill tried to make the phrase sound ridiculous. Instead, he reminded everyone why public health should not be written by people whose deepest medical credential is being loudly wrong near a microphone.

References

National Institutes of Health. (2024). #TranscendentHealth – Adapting an LGB+ inclusive teen pregnancy prevention program for transgender boys. NIH RePORTER.

UCSF Transgender Care. (n.d.-a). Information on testosterone hormone therapy. University of California, San Francisco.

UCSF Transgender Care. (n.d.-b). Fertility options for transgender persons. University of California, San Francisco.

USAspending.gov. (n.d.). Award profile: R01NR020846, #TranscendentHealth – Adapting an LGB+ inclusive teen pregnancy prevention program for transgender boys.

Ybarra, M. L., et al. (2025). Sexual health of U.S. transgender boys, nonbinary youth, and cisgender girls. JAMA Pediatrics.