I don’t know, and you probably don’t either.
A few thoughts of mine, with some recent references and links.
Uncertainty about “the science” doesn’t mean we must remain politically or scientifically silent. We can advocate for more, better, medical care, more research, and more support for children and families, and their doctors. We can obviously oppose malevolent regulations and bans such as those the extremely noxious Supreme Court majority is presumably about to bless. It is disheartening that instead of offering support, so many well-meaning people are demanding more — more patience, more understanding, more compromise — from a community that is being repeatedly punched in the face (e.g., by $215 million of anti-trans political ads).
It’s fashionable among well-read non-experts to believe “we” need to be more “cautious” or “slow down” with regard to gender affirming care for children. One journalist in the trenches on this is Jesse Singal who (according to him; the article is unsigned) just published a report (Economist | bootlegged) on a lawsuit by a former patient against a trans healthcare provider who allegedly didn’t follow proper precautions when administering gender transition care. If the facts of the case are as he describes them, it sounds like bad care, but the premise of the article is that the lawsuit will “rebut the notion that rushed youth gender transitions are rare” — based on a single case. Singal adds, “The share of Americans who regret their gender transitions, or who detransition, is unknown as well. Anecdotally there appears to be an uptick in the number of detransitioners seeking redress, says Jordan Campbell, one of Ms Breen’s lawyers.” The source there is the tell. Other mainstream media (especially, at times, the New York Times, critiqued here) also are contributing to an atmosphere in which lots of people express unhelpful opinions about policy.
Anyone who tells you the same proportion of people have always been trans, or that in the old days no one was trans (or no one is really trans), is speaking from ideology or personal perception rather than scientific evidence. Crucially, where the answer lies between those poles does not matter for the question of how we care for children (or adults) today. The decision whether to slow down or be cautious about changing behavior comes after you let the affected people have the right to make the choice, not before. The failure to recognize this is correctly read by the trans community as devaluing or dehumanizing.
I don’t want more children to go through a gender transition any more than I want more women to have abortions or more old people to have hip replacement surgery. I want people to have access to the care they need — including the care they think they need — and I want the scientific community to have the resources it needs to study and adjudicate all the evidence. In this I follow the considered recommendations of leading pediatric and psychological experts, for example, who support such care within appropriate — and, crucially, well-supported, well-resourced — practices. No responsible medical professional thinks any life-altering medical intervention should be undertaken recklessly. Lots of people are troubled by the dramatic global rise in babies delivered C-section, but reasonable people do not call for laws preventing patients and doctors from agreeing to undergo the procedure.
The social context matters. I have two very different minds about imaginary futures in more egalitarian social worlds. In one, trans people — with or without gender dysphoria — would be able to experience comfortable, affirmed, lives without drugs or surgery, because societal acceptance would alter the conditions under which we construct our mind-body relationships. In the other, with more advanced medical care, people making adjustments to their bodies to fit their identities or imaginations would be normal and accessible and not that big a deal either. I can’t say which of these worlds would be better, which is more likely, or whether we could have both — but that doesn’t affect my views on the contemporary political repression of trans people and their scapegoating by today’s marching forces of fascism.
The appropriate frequency of gender affirming care for minors is exactly the kind of opinion non-experts should not have. We know, we know, that many children benefit from gender-affirming care (and also that many do not end up needing, or choosing, to use puberty blockers, hormone therapies, or surgery). The cases in the Tennessee brief are simple and clear. For regular members of the concerned public, this is what we need to know: This can be vital, positive, and life-altering care that saves lives. If you care about children, you want them to have access to this care if they need it. We should not be standing on the sidelines cheering the numbers going either up or down.
Medical interventions, including gender affirming care, have side effects and unintended consequences. Some people regret their medical gender transition procedures, and some seek to reverse them. Although small numbers, disparate practices, and different interventions, make it difficult to generalize and pin down the measures or the associated numbers, it’s clear that “regret” for gender transition occurs very infrequently, and less than it does for many, far less controversial interventions, including cosmetic surgeries, for which those related to gender transition are a small minority. This figure shows that the vast majority of people (especially minors) having breast reductions are cisgender males, not trans people (isn’t this also gender affirming care?).
I’m not suggesting we should take no position on political decisions regarding medical care. The restriction on gender-affirming care for children recently applied by the United Kingdom’s National Health Service (now extended) was based on a report known as the Cass Review, which has been heavily criticized (e.g., here, here, here). I think it is wrong because it limits the options of patients and their doctors who are being as cautious and considered as anyone should be, and practicing good medicine. The policy singles out gender affirming care for an unreasonably high standard of scrutiny. Instead of restrictions, we should be thinking about how to increase access to more, better, medical care, more research, more support.
My unpopular opinion is that we need to make sex and gender less exceptional. Lots of medical procedures involve “irreversible” changes. That nightmare you have about your teeth falling out is because of the shocking realization that nothing — nothing — can make an adult tooth come back, so they reflect mortality itself (that’s my interpretation; Freud thought the dream represented “castration as a punishment for onanism“). Of course, the younger the patient, the more concerning any irreversible effect will be. But if you want to restrict gender transitioning treatments for minors but allow ignorant parents to throw their kids into the high school football brain buzzsaw, you’re not really thinking about children’s well-being.
Sex and gender (and fertility) are not sacred, and don’t belong on a medical pedestal. They are as important as people think they are — and by people I mean the children involved, their parents, and their doctors (not you). Children considering gender affirming care do not need legislative (or bystander) intervention more than those considering cancer surgery, tanning, or other cosmetic procedures (the most common for people age 19 or younger are breast reduction, nose reshaping, and liposuction, which together accounted for 13,000 surgeries in the US last year [the industry is reluctant to publicly promote most cosmetic surgeries below age 18, but these are often considered reasonable exceptions]).
We should be curious and concerned, but the clear priority now is to support trans children and their families, who are under concerted, global attack, to get the medical care they need.
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Previously Published on familyinequality with Creative Commons License
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As with many sensitive things, there is a burden on fiduciaries to balance care and loyalty. You may have someone who wants (or whose parents want) to radically change a lot of things surrounding gender. But until you are sure that this person has matured enough to make a reasonable decision, it is reckless beyond belief to start ‘transitioning’ in a permanent, medical way.