Dear Senator May and Assemblymember Reyes

About A6761/S8352

New York State Senator Rachel May
Assemblymember Karines Reyes

Dear Senator May and Assemblymember Reyes,

I was born in upstate New York and have lived most of the last 30 years in New York City. I’m a lifelong Democrat, the sister of a lesbian, and cofounder of an LGBT organization. I’ve written a nonfiction book on the history, science, and psychology of gender nonconforming girls, another on the history of women’s work, and am at work on a book about the youth gender culture war. I’m also a public school parent of a gender nonconforming teen who has been that way since age 2, and an extremely gender conforming tween.

I am writing to you in my capacity both as a parent and as a journalist who, through years of exhaustive research, has developed some expertise about gender dysphoria in youth and on transgender children. I feel desperate for fellow liberals, especially those who are crafting legislation, to understand these issues in a more complex way.

Your bill, A6761/S8352, seems intended to ensure homeless youth can get the medical and psychological services they need. With nearly 120,000 thousand homeless students in New York City alone, it’s clear how important this is—they need to be able to get their teeth fixed, get therapy, get their prescriptions filled, no matter their living situation or what’s happening with their parents.

But gender-affirming care is a completely different story. It’s true that major American medical groups endorse it and claim it is both evidence-based and lifesaving. And I know that the Republican bans seem particularly cruel, and many blue states are passing legislation in reaction to them, or because they believe it’s the right thing to do.

Some young people have been helped by transition—as have many adults. But that doesn’t mean that this approach is the right way to facilitate it. For the past three years, I have chronicled the stories of children and families hurt by the affirmative approach—stories I tried to get into the liberal media because few of us seem to know them. They include families whose children have been removed from the home by CPS because the parents didn’t affirm; children whose mental health worsened after transitioning, often because their other mental health problems weren’t addressed; children who’ve gone through unimaginable horrors because of the perception that unaffirming parents are a danger to their children—outcomes ranging from sex trafficking to suicide. The American Academy of Pediatrics is currently being sued by a young detransitioner because of its affirmative policy statement.

We must stop denying that some children are getting gravely hurt, and some families are being torn apart. There is no research that says a child who runs away to medically transition will fare better than a child who lives with parents and has to wait until adulthood. I beg you to listen to those of us on the left who are concerned about the gender-affirmative approach, including adult trans and gay people, many of whom I’ve interviewed.

Youth transgender medicine is based on Dutch protocol developed in the late 1990s and imported to America in 2007, for a very specific population. Those allowed to medicalize had suffered from lifelong gender dysphoria; lived in supportive families’ weren’t suffering from other mental health issues; and had dysphoria that worsened at puberty. These children were not socially transitioned—to take on the identity of the opposite sex, and change names and pronouns—because that treatment was thought to increase the likelihood of worsening gender dysphoria and medical intervention at puberty, and most children’s dysphoria dissipated by the end of puberty; the majority grew up to be same-sex attracted.

The thought behind this new protocol was that early medical transition would help them pass better as the opposite sex because they didn’t go through natal puberty. Many transitioned adults—mostly trans women—had very high suicide rates, in part, perhaps, because they couldn’t pass as the opposite sex. Early research on this new youth cohort seemed to indicate that the protocol alleviated their gender dysphoria and they continued to function well.

Not long after this practice began at Boston Children’s Hospital, other clinicians decided to advance a new approach: the affirmative model. This meant focusing on the child’s perceived gender identity, allowing them to socially transition at any time, and not positioning clinicians as “gatekeepers,” who stood in the way of children realizing their authentic selves. This was not based on the evidence of the Dutch, but on other research that suggested familial rejection led to worse mental health outcomes.

But what I and others have found in the past few years is that both the Dutch research and the family acceptance research were deeply flawed—biased, and not establishing causation between the treatment and alleviation of either gender dysphoria or suicidality. The only long-term research conducted in this country revealed a shockingly high completed suicide rate, 2 in 315—and this was in a cohort of affirmed and medically transitioned youth. Nowhere does research say that parents who struggle to accept their trans children should be removed as guardians or rejected. The literature in fact suggests that families can stay intact and loving even if members disagree.

With the proliferation of the affirmative model has come an increase in detransitioners who regret transitioning, as well as an unprecedented and exponential increase of teens with no history of gender issues, whose symptoms don’t resemble those of the kids the Dutch protocol was first developed to help. Thus, several European countries have shifted their guidelines to make them even stronger and stricter than the original Dutch approach. They offer psychosocial support as the first line intervention; require a multidisciplinary team to evaluate children over a long period; and maintain parental involvement. They don’t see these psychological and medical interventions as a human right but as serious treatments that require familial participation and careful evaluation, and offer them only in the context of clinical trials.

Recent polling suggests many liberals agree and are concerned—but so many people are afraid to speak up in this environment. Several state Democrats have joined Republicans in limiting gender medical interventions to adults. We believe this is not a left/right issue, but an issue about science versus belief. We uphold the Democratic values of inclusivity and pluralism, and support gender diversity. Cost-benefit analysis is the backbone of policymaking, but we cannot make good policy without acknowledging the cost. And in this case, consider the costs: broken bodies, broken families, and our own party passing legislation that could lead to more of the same.

I would be happy to talk to you more about this and can introduce you to a broad coalition of lefties and LGBT people who want lawmakers to understand the full complexity of this issue.

Many thanks,

Lisa Selin Davis
Brooklyn, NY