Irreversible
This row has emerged from one of the most contested issues in medical science today: whether gender-questioning children should be put on an irreversible medical pathway, taking drugs to block puberty and ultimately progressing onto cross-sex hormones. I’ve written about the background to this here: an independent review undertaken by the paediatrician Hilary Cass called an overdue halt to this practice in the NHS. But her review controversially left the door open for a clinical trial of puberty-blocking drugs.
That trial is controversial because many experts (in my view, rightly) think it is impossible to to run an ethical trial of puberty blockers on gender-questioning children. I highly recommend this post from Genspect, and this open letter to health secretary Wes Streeting signed by hundreds of clinicians that explain why. It’s not possible to do them justice in a short summary. But for me the fundamental ethical problem at the heart of a puberty blocker trial is as follows.
The evidence we have is that for most children, gender dysphoria resolves naturally through puberty. Cass in her review is rightly concerned that subjecting these children to medical intervention that blocks their natural development will bake in mental distress that would otherwise be temporary.
That’s two radically opposed viewpoints there. One is that gender dysphoria is permanent and agonizing, and the other is that it’s a childhood blip that fades out as childhood recedes into the distance.
What trans ideology has done here is make the childhood blip [assuming it is a blip] into a tragic yet deeply meaningful permanent condition that can be made joyous via radical permanent changes to the body.
That’s quite the gamble right there.
It’s sort of as if there were a passionate dedicated vituperative movement to perform all sorts of surgeries and medical interventions on children to “affirm” them in whatever fantasy has most besotted them. Transform them into Spock or Elsa or Woody when they’re 10, what could possibly go wrong?
So much. So much could go wrong.
Gender activists who insist that, without medical intervention, gender dysphoria is permanent are able to point to children and young adults who have been steeped in the message that, without medical intervention, their gender dysphoria is permanent. Look how they persist! We told
themyou so!We should have learned after the Satanic Panic that “trust the children” is a weak form of evidence. “They know who they are,” is a lot to put on a kid who is not even old enough to provide meaningful consent to sex, especially when pressured by a trusted adult. The peer pressure that affirms kids who even question whether or not they might be trans or NB, whether or not it is because they don’t like the toxic masculinity that they don’t want to express or for girls the pressure to be subservient or girly-girls, has grown stronger because it has been reinforced by adults who should know better.
To even start a course of adolescent cross-sex hormones should be thought of as unconscionable. I can’t believe the number of people who say that “it’s perfectly safe” is especially dispiriting because there are no medicines that don’t have some sort of side effect and stopping or delaying puberty has a whole host of known side effects. Most of our organ systems make radical changes during puberty, and halting those processes is going to have effects that we just aren’t counting on when we start kids on puberty blockers so that their appearance as adults matches the sex they think they want to be affirmed as. Cass pointed out that gender uncertainty does resolve itself as kids mature, but if they have started on a course, then it can be too late to undo the damage. Further, we all know how the “sunk cost fallacy” works. Once someone has committed to a course, they are very likely to stay with that course. When I was in Seattle in 2020, I was invited to a meeting of detrans young adults and they, as well as their family members talked about how they were led to believe they were trans and all of the psychological and medical problems they were experiencing while they were healing.
Particularly damaging was the feeling of abandonment by people they had thought they could trust once they confided that they had made a mistake. They were lovebombed as long as they were on their dangerous course, but discarded and even hated once they tried to get off and return to their lives.