The Paid ‘Experts’ Defending Anti-Trans Laws | EUROtoday

Hruz is a part of a small however prolific roster of skilled witnesses who crisscross the nation to testify in protection of anti-trans legal guidelines and insurance policies going through a authorized problem. Pulling concepts from the fringes of medication, their goal is to persuade judges that gender-affirming care is scientifically controversial, pointless and harmful.

Most, like Hruz, apply medication in a area associated to gender-affirming care — resembling psychiatry or endocrinology — however have handled solely a handful of adolescent sufferers for gender dysphoria, if that, and haven’t revealed related analysis. Several belong to overtly anti-trans teams and have urged state legislatures to move the very legal guidelines they receives a commission to defend.

Some of probably the most outstanding witnesses have been recruited by the Alliance Defending Freedom, a conservative authorized powerhouse whose mission is to understand a rustic ruled by far-right Christian values. And many share ADF’s excessive antipathy towards LGBTQ+ individuals.

“They’re hired guns,” mentioned Omar Gonzalez-Pagan, a lawyer for the LGBTQ+ rights group Lambda Legal who has confronted Hruz and his cohorts in a number of instances. “These are not real experts. They’re manufactured as experts by the opponents of transgender rights.”

Still, for a charge of a whole bunch of {dollars} an hour, they will lend a sheen of scientific rigor to highschool toilet restrictions and bans on gender-affirming care.

And they’re more and more having an affect. On Aug. 25, a Missouri decide quickly upheld the state’s four-year ban on most gender-affirming remedies for minors, writing, “The science and medical evidence is conflicting and unclear.”

HuffPost scoured hundreds of pages of courtroom filings and dozens of state vendor databases and filed greater than 40 public data requests to get a full image of their rising cottage trade. The search revealed that these skilled witnesses routinely pull down 5 figures in return for just some weeks of labor. Since 2016, state and native governments have spent greater than $1.1 million on skilled testimony, a lot of it going to only six go-to witnesses.

Some states additionally employed high-priced exterior authorized groups, at a price of one other $6.6 million. The University of North Carolina employed the conservative authorized large Jones Day for as much as $1,075 an hour after changing into embroiled within the state’s 2016 toilet ban.

All these figures doubtless undercount the true price by at the least half: Out of greater than three dozen state and native companies that defended anti-trans legal guidelines in courtroom, fewer than 20 disclosed their spending.

For years, these consultants have struggled to ascertain their credibility in courtroom. Judges have discovered their testimony to be “biased,” “illogical,” “conspiratorial” or based mostly on fabrication, or tossed their testimony in its entirety for having no foundation in analysis. More than a dozen main U.S. medical associations have endorsed gender-affirming care as medically obligatory, together with for adolescents.

Florida Gov. Ron DeSantis’ administration enlisted almost each skilled witness of word to craft and defend a 2022 state ban on Medicaid protection for transition care. Yet all of the witnesses mixed, within the phrases of U.S. District Judge Robert Hinkle, might muster “no evidence that these treatments have caused substantial adverse clinical results in properly screened and treated patients.” Hinkle struck the ban down in June.

But for the primary time, different courts have begun to purchase their arguments. Fortified by a perception that attacking trans individuals is “a political winner,” in 2023, state lawmakers, largely Republicans, have launched greater than 550 new payments assailing trans well being care and authorized recognition. Not solely are the consultants having their busiest 12 months because of this, however they’ve notched a number of vital successes.

In July, a sixth U.S. Circuit Court of Appeals panel allowed Tennessee’s ban on gender-affirming care to stay in place whereas a authorized problem proceeds. In August, an eleventh U.S. Circuit Court of Appeals panel reinstated Alabama’s ban on puberty blockers and hormone remedy for trans youth.

The courts, making use of the identical reasoning the Supreme Court used to overturn Roe v. Wade, dominated transgender care just isn’t constitutionally protected and that states solely want some rationale to manage it. The skilled witnesses have been key to cultivating the impression that the medical group is split. “The medical and regulatory authorities are not of one mind about using hormone therapy to treat gender dysphoria,” wrote the sixth Circuit panel.

The rulings enhance the percentages of a cut up among the many circuit courts and the chance that the Supreme Court will ultimately take up the problem of gender-affirming care.

And within the meantime, these consultants have helped block medically obligatory look after hundreds of trans individuals across the nation.

“They’re wasting their time and their energy and money trying to convince me and people like me we aren’t who we say we are, and we aren’t who we feel we are,” mentioned Dylan Brandt, a highschool senior and the lead plaintiff difficult Arkansas’ first-in-the-nation ban on gender-affirming look after trans minors.

“I’ve known for a long time exactly who I am, and I am so much happier now that I can express and show who I am. For people to be trying so hard and using so much time and effort to stop me — that’s hard.”

Besides Hruz, the core group of experts includes James Cantor, a Canadian psychologist; Stephen Levine, a clinical psychiatrist whom prisons often enlist when they are facing pressure to provide gender-affirming care; Patrick Lappert, a former plastic surgeon, who has said he considers gender-affirming surgery “diabolical in every sense of the word”; Michael Laidlaw, an endocrinologist who has urged lawmakers to criminalize gender-affirming care; and Quentin Van Meter, a pediatric endocrinologist and the former head of the anti-LGBTQ+ American College of Pediatricians.

This ragtag group of outliers did not find their way into the courtroom at random. Dismayed at the “poverty of people who are willing to testify” in defense of anti-trans laws, according to Lappert, the Alliance Defending Freedom, one of the most formidable forces on the religious right, held a conference in Arizona in 2017 to identify potential recruits. Lappert, who later described the conference in a deposition, Hruz, Van Meter and a California family physician named Andre Van Mol all attended and became go-to witnesses soon afterward. A few years later, the ADF enlisted Cantor to his first case — a lawsuit brought by another expert witness who claimed his university fired him for his courtroom work.

ADF’s recruitment effort paid off right away. Around the same time as the conference, Ashton Whitaker, a 16-year-old transgender boy, became one of the first students to sue over his school’s bathroom ban. An administrator at his high school, part of Wisconsin’s Kenosha Unified School District, had gone so far as to suggest he wear a bright green wristband so teachers could monitor his restroom use, the lawsuit said.

The legal team Kenosha hired spent months poring over past cases and medical journals for potential expert witnesses, according to records obtained by HuffPost — a search that produced little more than several thousands in legal bills and a list of people who seemed “likely favorable” toward the ban. Then a lawyer reached out to the Alliance Defending Freedom, and Kenosha finally retained an expert: Hruz.

ADF plays a central role in the mounting backlash to LGBTQ+ rights — the witness roster is just one piece. The group, envisioned by its founder as a “Christian legal army,” has a $104 million annual budget and drives impact litigation around the country. On gender issues, it has helped organize a diffuse group of reactionary and religious-right lawmakers, lawyers and activists into a sprawling working group that trades model legislation, coordinates PR campaigns and fine-tunes bills to withstand legal challenges, a recent Mother Jones investigation found.

Several of the expert witnesses are active members of the working group, such as Laidlaw. Emails leaked to Mother Jones show he told lawmakers that gender-affirming surgical procedures are “crimes waiting to be recognized and codified into law.”

Kenosha lost its trial and a subsequent appeal. After that, ADF began closely coordinating with Kenosha’s legal team to try to appeal the case before the U.S. Supreme Court. They spent weeks strategizing on the legal approach and amicus briefs before the district ultimately chose to settle.

Opponents of trans rights lost most of their early legal battles in the late 2010s and early 2020s — Kenosha was just one. But the new cadre of experts has no shortage of work. Although their No. 1 assignment today is to defend bans on gender-affirming care for minors — these target puberty blockers and hormone therapy — the core group of experts has defended every variety of anti-trans policy under the sun, from school sports and bathroom bans to orders to investigate parents for child abuse if they support their child’s transition, to bans on gender-affirming care for adults.

The most prolific is Cantor, the Canadian psychologist, who has been a witness in 24 cases total, 11 this year alone. Close behind are Levine, who has been a witness in at least a dozen challenges to anti-trans laws and is the only defense witness with substantial experience treating transgender people, and Hruz.

Most of them bill between $200 and $650 an hour — which is standard for an expert trial witness — for writing reports, giving depositions and trial testimony, and traveling. When Cantor testifies in person versus over video, he said in an interview, he usually earns an extra $10,000 for traveling and waiting his turn in the courtroom.

In Brandt v. Rutledge, the case in which Dylan Brandt is the plaintiff, Arkansas paid Hruz, Lappert and Levine more than $40,000 apiece, records show. (“Yes, I find it pays well, but not nearly as well as your information suggests,” Levine said in an email.)

Mark Regnerus, a sociologist who testified, pocketed $57,062. Regnerus is a veteran of the expert witness circuit, having previously testified that children of same-sex couples grow up at a disadvantage in defense of bans on same-sex marriage. Hruz, a few months after he submitted his expert report to Arkansas, sold a “nearly identical” version to North Carolina, court records show.

“It’s not a difficult job for $200, $300, $400 an hour,” said Carl Charles, a senior attorney at Lambda Legal. But few are willing to do it, he speculated, because “These bills do real harm to young people and to their families, and I think doctors take that pretty seriously.”

Cantor, the Canadian psychologist, does not share the religious mission of groups like ADF. He credits “his inner Vulcan” for his ability to testify in cases that involve banning a 10-year-old trans girl from playing on the girls’ softball team or stopping adults from correcting their gender on their government documents, to name two recent examples.

“When I first started getting contacted by these groups, it was a long, hard conversation I had to have with myself,” he said. “It’s not up to me, I ultimately decided, what society does. That’s up to society.”

Although he has defended more policies involving trans kids than any other expert, Cantor has never counseled a transgender child or teenager. He has never carried out original research involving trans people, either. His expertise is in paraphilia: abnormal sexual desires, such as pedophilia. And he has acknowledged in court that gender dysphoria — the distress a person feels when they don’t identify as their sex assigned at birth — is not a form of paraphilia.

In a 2022 deposition over West Virginia’s ban on trans girls playing in school sports, Cantor failed to recall the names of any puberty-blocking drugs: “Oh, I couldn’t tell them to you by name so much as by function,” he said. “I’ve always been bad with names,” Cantor told me. “These drugs have had different names in different countries at different times.”

Cantor believes his lack of direct experience allows him to evaluate the field dispassionately.

“The best analogy I have is that, if you want to know if fortunetelling is valid, you’re not going to find that out by just asking the fortunetellers,” he said.

A deposition he gave last summer defending Indiana’s ban on trans girls playing girls’ sports suggests he does not believe trans adolescents are really trans, but are primarily either gay, young and “mistak[ing] the emotions that they’re having” for gender dysphoria, or have autogynephilia, an outlier theory holding that some trans women are merely aroused by the thought of themselves as a woman.

“It’s just a different phenomenon that only looks similar superficially” in children, he said in our interview.

He also argues that studies “consistently, even unanimously” find that the majority of youth who identify as trans stop doing so after a few years. But many of the sources he has cited aren’t studies of trans kids: In multiple examples, the researchers didn’t differentiate between kids who consistently and persistently identified as trans and kids who just behaved in ways associated with the opposite gender. Several studies are decades old and have research topics like “the sissy boy syndrome.”

More recent research finds very low rates of detransitioning among children who socially transitioned, and for reasons that include social pressure and a lack of parental support.

Cantor earned $23,400, he said, defending Texas Gov. Greg Abbott’s notorious directive to investigate the parents of children who receive gender-affirming care for child abuse. In the case over Alabama’s ban on gender-affirming care for minors, he earned $52,400. Because of his lack of experience treating trans youth, the judge in that case, Liles C. Burke, a Trump appointee, ruled that Cantor’s testimony held “very little weight” and blocked the ban from taking effect. A dozen states have nevertheless asked him to be an expert witness since that May 2022 ruling. The 11th Circuit Court of Appeals reversed Burke’s ruling a few days after we spoke.

“The question in the back of people’s heads is, is he only saying this for the money?” Cantor said in our interview. “If my assessment of the literature was the other way around, I’d be working from the other side. It wouldn’t make a difference. So it’s good that I’m getting paid, right?”

Levine declined to be interviewed because he is an expert witness in at least one ongoing case. (HuffPost contacted all the experts named in this story and was unable to reach Lappert despite multiple attempts.) In response to specific questions, Levine wrote, “Your questions illuminate how information can be dysinformation [sic] or simply wrong. Like delusions that often contain a kernel of truth, it is the distortions of reality that enable the label delusion.”

In 1997, he chaired a committee of the organization known today as WPATH, which develops the best practices for treating gender dysphoria. He cut his ties, however, after WPATH became too responsive, in his view, to trans advocacy.

Before he started defending anti-trans laws as an expert witness, Levine provided expert testimony for prisons seeking to block trans inmates from socially transitioning or receiving gender-affirming care, which prisons often oppose for cost reasons.

In that role, Levine has also questioned whether trans people are genuinely trans or if their gender dysphoria is actually an expression of deviant desires or something unresolved from childhood, like “excessively symbiotic” mothering. Of one trans inmate, he wrote that her “transgenderism is tied very much up to her narcissistic character, her demanding character.”

Van Meter, the former president of the American College of Pediatricians, or ACPeds, has appeared in at least six cases. Like ACPeds’ original founders, he became disillusioned with the American Academy of Pediatrics and sought an alternative because the AAP would not endorse the superiority of the “intact, married family” over same-sex parents and single mothers, he said in an interview.

Van Meter has seen a very small number of adolescent patients with gender dysphoria but says he believes the root cause in “100%” of cases is their family environment. “Divorce is probably the most common thread in all of these cases,” he said. He refers these patients to counseling for depression and anxiety, believing it will resolve their gender dysphoria — an approach with roots in gay conversion therapy that research has linked to an increased risk of suicide attempts.

“You basically ruin their lives” by allowing adolescents to transition, Van Meter said, and so at every opportunity, he pressures them to abandon the idea. To one of his current patients, “I have said it a bazillion times … You will always be a biological female.”

“You have a group of people who say they exist, and what they are saying is, ‘No you don’t. You’re not real, you’re sick,’” said Michelle Forcier, a professor of pediatrics at Brown University and a clinician specializing in gender-affirming care. “Let’s be clear: These are adults who are bullying children.”

Dylan Brandt determined to not be within the courtroom on the times that Arkansas introduced its case, however his mom, Joanna Brandt, was. The hardest second for her was when Regnerus, the sociologist against same-sex parenting, minimized the chance of suicide amongst trans youth, saying researchers had “doc[ed] pretty small numbers of truly accomplished suicides.”

“If we distinguish suicidality from actual suicides — completed suicides — we see a much more narrow story validated,” he mentioned.

Joanna considered Dylan and felt the sting of tears.

“I was afraid I would start loud, ugly crying, so I got up and left,” she recalled. “How could you come here and talk about these people that you’ve never spoken to, that you don’t know anything about, in such a way? Actual lives are being saved by affirming care, and nobody on the state side cared about that.”

Hutton by no means forgot her lunch with Hruz. And within the years that adopted, as Hruz developed his aspect hustle as an skilled, she started to testify at among the identical trials that he did.

In a 2017 case the place Hruz was defending the St. Johns County School District’s toilet ban, she recalled earlier than a courtroom in central Florida how Hruz had mentioned her baby may be “born to suffer and die.” This summer time, she flew all the way down to Tallahassee to face off in opposition to Hruz once more, this time over the state’s Medicaid ban. (She was solely reimbursed for journey.)

Her purpose is for the courts to know his true motives. “I know he’s wrapping his whole presentation up in court now as based on science, but that is not what is driving Paul Hruz,” Hutton mentioned. “It is religion.”

Hruz just isn’t the one skilled who seems to have spiritual motivations.

Lappert, the previous plastic surgeon, is a chaplain in Alabama for a Catholic group known as Courage, which, in response to its web site, counsels “men and women with same-sex attractions in living chaste lives.” In a 2018 presentation titled “Transgender Surgery & Christian Anthropology,” he mentioned “the challenge” at hand was “evangelizing people who are being relentlessly [misled] concerning human sexuality.” They wanted “catechesis” and “the sacraments.”

Van Meter, on studying that Gov. Brad Little of Idaho had signed two payments the group supported, boasted, “God is with us!”

“It’s not that I’m driven by a religious ideology,” Van Meter mentioned in an interview. “I do use that as a battery pack, during the weary times, to say, don’t give up, there is a reason you are here.”

Courts place few restrictions on who can function an skilled witness, so long as their testimony is related and soundly reasoned. The bar is low sufficient that teams suing to overturn anti-trans legal guidelines hardly ever problem these consultants’ skill to testify. But once they do, courts have discounted their testimony in about half of instances.

“Hruz fended and parried questions and generally testified as a deeply biased advocate, not as an expert sharing relevant evidence-based information and opinions,” Judge Hinkle wrote when he blocked Florida’s Medicaid ban. Another decide known as his testimony “conspiratorial.”

Levine has had elements of his testimony struck a number of instances, together with for counting on a fabricated anecdote.

There are moments within the courtroom when the dearth of qualification on the protection aspect is apparent. During a deposition defending Florida’s Medicaid ban, G. Kevin Donovan, who lately retired because the director of Georgetown University’s middle for scientific bioethics, claimed that almost all transgender women ultimately “revert in their self-perception.” But when pressed for his sources, he flailed.

Q: “What is your evidence of that statement?”
A: “Oh, that — that’s been widely published and repeatedly published.”
Q: “Can you name the study that that information comes from?”
A: “I’m sure I could. It’s more than one source, but, yeah.”
Q: “Can you name those studies?”
A: “Not right now, no.”

Records present the Florida Agency for Health Care Administration paid Donovan $34,650. He didn’t reply to questions on his testimony.

The different aspect has its consultants, too. Typically, they’re clinicians who’ve supplied gender-affirming care to a whole bunch of trans individuals or revealed substantial analysis on gender-affirming care, or each.

The skilled witnesses for the protection, missing the identical breadth of expertise, usually attempt to poke holes within the analysis supporting gender-affirming care, largely by nitpicking and misrepresenting the proof or ignoring newer research in favor of dated ones. “Their way of operating is to look at each study, say it has limitations, and because it has limitations, to disregard it entirely,” mentioned Gonzalez-Pagan, the Lambda Legal legal professional. “And the pile of evidence never grows because they keep finding reasons to disregard studies.”

Many have seized on the very fact that there have been no long-term, randomized managed trials to check the efficacy of puberty blockers and hormone remedy for treating gender dysphoria.

Framing randomized trials as the one legitimate type of proof lets them ignore the big physique of observational and scientific information that does help gender-affirming care. Nearly 20 research with elements of randomized trials — that observe trans adolescents receiving gender-affirming care over a protracted time period, or examine outcomes for trans individuals who accessed gender-affirming care with those that didn’t — have related gender-affirming care with higher psychological well being outcomes, resembling reductions in despair, nervousness or ideas of suicide.

Those optimistic associations make it unethical to run a randomized trial over the long run, particularly one involving adolescents. “You wouldn’t randomly assign people to smoke a pack a day,” mentioned Briana Last, a analysis psychologist at Stony Brook University, including that scores of widespread medical practices have been established with out randomized trials.

And, prior to now few weeks, researchers have revealed a randomized trial of 64 transmasculine adults displaying that suicidality declined by greater than half for the contributors who acquired therapy immediately.

The analysis that skilled witnesses for the protection don’t ignore, they usually distort. Many, particularly Levine, have argued that transition care is doubtlessly dangerous by pointing to a 2011 Swedish research that discovered that trans individuals who had gender-affirming surgical procedure nonetheless had a 19.1% increased suicide charge than the final inhabitants.

But the lead writer, Cecilia Dhejne, says that may be a blatant misrepresentation of the research, which really confirmed that offering medical care just isn’t sufficient with out additionally combating societal discrimination.

When he deposed Levine in 2022, Charles, the Lambda Legal legal professional, learn Dhejne’s critique of how Levine misused her analysis out loud. Undeterred, Levine cited Dhejne once more this 12 months in help of Florida’s Medicaid ban.

Several of those consultants have argued that different international locations, such because the U.Ok., Finland, Norway and Sweden, have severely restricted puberty blockers and hormone remedy for adolescents. “They’ve decided that in all, it’s experimental and does more harm than good, and they’re stopping,” Kristopher Kaliebe, who has testified in three instances, mentioned in an interview.

But in actuality, none of these international locations have imposed outright bans. In the U.Ok., the National Health Service is limiting the long run use of puberty blockers to adolescents enrolled in a analysis research, and puberty blockers and hormone therapies stay accessible by means of personal care. In Finland, transgender adolescents who meet sure standards can obtain puberty blockers and hormones on the nation’s two main analysis hospitals. Reports of Norway banning gender-affirming care are merely false and propagated by web sites identified for spreading misinformation. Sweden’s medical board urged clinicians to make use of “caution” with puberty blockers and hormones for adolescents however didn’t name for a ban, and specialised suppliers proceed to supply the therapy.

Gender-affirming care suppliers acknowledge their area faces unanswered questions and that folks’s understanding of their gender identification can deepen over time.

Before puberty, Forcier famous, gender-affirming care consists largely of supporting youngsters in the event that they wish to gown or minimize their hair in a different way or go by a brand new identify. “The vast, vast majority will say, this is what I need and where I want to be,” she mentioned, however “it’s OK to change your mind if you’re more gender fluid, it’s OK to change your plan.”

Opponents of gender-affirming care, she argued, aren’t bent on finding out and enhancing care however on eradicating it. Recently, a former worker, Jamie Reed, accused Washington University’s gender clinic of speeding adolescents on to puberty blockers and hormones. While her core claims seem like proving false or alarmist — one father or mother mentioned Reed “twisted” her baby’s medical historical past; out of almost 1,200 sufferers who sought care on the clinic, Reed claims 16 detransitioned — the primary problem the clinic seems to face is overwhelming demand. Missouri’s response has not been to extend funding for adolescent trans care, however to move a ban.

“I’m not seeing these people say, ‘This is such an important problem, let’s shift money from white male cardiovascular research to gender care,’” Forcier mentioned. “They are making these arguments in favor of a ban.”

Out of all the federal government workplaces requested to justify their hiring of those consultants, solely the Florida Agency for Health Care Administration, which wrote the state’s Medicaid ban, responded.

“Our process has been transparent and based on factual evidence that we put out for the world to see,” mentioned Bailey Smith, the company’s spokesperson, hyperlinking to a webpage containing the skilled studies from Hruz, Laidlaw, Levine, Van Meter, Lappert and others. “Maybe you just fear the evidence will challenge your biased view of the world.”

The spike in anti-trans laws means states want much more consultants to defend it. And in order to deepen the bench, states have began enlisting lecturers who aren’t in well being care or don’t even primarily analysis people.

One is a Manchester University professor named Emma Hilton, who primarily research a selected species of frog and the way it provides an understanding of inherited human genetic problems.

Hilton is a founding father of a British group, Sex Matters, that advocates for legally segregating areas by intercourse. She earned $300 an hour final 12 months defending bans on trans women taking part in on women’ sports activities groups in Utah and Indiana. By means of explaining why she was certified to weigh in on college sports activities, she informed one courtroom, “I participate keenly in sports at an amateur level, playing netball recreationally.”

“Our understanding of human biology is in part a result of the study of animal models,” Hilton mentioned in an e-mail. She declined to handle the relevance of netball, which is like basketball with out dribbling.

Another is Michael Biggs, an Oxford sociology professor who admitted in courtroom to writing transphobic tweets underneath the pseudonymous deal with @MrHenryWimbush and described himself as a “teenage shitlord [turned] Oxford professor.” “Transphobia is a word created by fascists, and used by cowards, to manipulate morons,” reads one consultant put up.

Florida paid Biggs $400 an hour to defend its Medicaid ban. But he performs one other, extra essential position within the skilled pantheon: churning out publications that query the efficacy of gender-affirming care. One of his oft-cited critiques of puberty-blocking hormones relied on a questionable studying of hormone trials in sheep, wherein the sheep appeared to have nervousness. The different consultants have cited Biggs scores of instances.

Dylan, the teenager challenging Arkansas’ ban on gender-affirming care, avoids thinking about a future in which these people’s arguments carry the day. Instead, he thinks about going to college in a state that isn’t hostile and studying education. “I’ve dealt with a lot of bullying, but I’ve had some pretty amazing teachers [who’ve] given me a safe place,” he mentioned. “I want to be that for somebody else.”

His lawsuit has already made a brief shelter for different trans youngsters. In June, a judge struck down Arkansas’ ban. The state had assembled a who’s-who of experts — Lappert, Hruz, Levine and Regnerus — but “failed to prove that gender-affirming care for minors with gender dysphoria is ineffective or riskier than other medical care provided to minors,” in the words of U.S. District Judge James M. Moody.

“He knows better than any of these people, better than I do, who he is, and none of them have any right to tell him any differently,” Joanna said of her son.

“When I started testosterone, I felt like I could breathe normally for the first time,” said Dylan. “In the past three years, I have been able to look at myself in the mirror and smile. It’s changed my life — it’s saved my life — in so many ways.”