The Trouble With Texas, Part 2

Is this mess really about fertility?

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Thanks to the San Francisco Chronicle for publishing my piece about Texas last week (and I’d appreciate it if you’d thank them, too). As far as I know (please correct me if I’m wrong), it was the only mainstream media publication to mention, in a piece about Gov. Abbott and AG Paxton’s move to call gender-affirming care child abuse, that France and Sweden largely abandoned medicalizing gender-affirming medical interventions for youth at the same time. (France noted, “there is no test to distinguish a ‘structural’ gender dysphoria from transient dysphoria in adolescence.”) To me, this seems like something that every article about the subject should note, no?

Why Abbott and Paxton would resort to these measures has been cause for speculation. People often assume it’s for political power, or because they hate trans kids. The consequence—beyond the horror of terrorizing parents trying to help their suffering kids—is the Left doubling down on uncertain science and false statistics about suicide, which does not help those of us trying to complicate the media narrative.

Reading through AG Paxton’s opinion, I was stuck by another possible motivation, this one also, it seems, largely ignored.

The very first thing he discusses with respect to gender-affirming medical interventions is that they cause “sterilization through castration, vasectomy, hysterectomy, oophorectomy, metoidioplasty, orchiectomy, penectomy, phalloplasty, and vaginoplasty” and that “providing, administering, prescribing, or dispensing drugs to children [induces] transient or permanent infertility.” Paxton says he is protecting children from physical or psychological harm, but also protecting “the fundamental right to procreation.”

A substantial portion of his opinion is devoted to the sterilization of children. He writes: “The novel trend of providing these elective sex changes to minors often has the effect of permanently sterilizing those minor children.”

I am not personally certain about the science around this claim, though the chief physician and pediatric endocrinologist of Karolinska University Hospital, Richard Nergårdh, called giving children puberty blockers “chemical castration.” One study noted that “Suppression of puberty with gonadotropin-releasing hormone agonist analogs (GnRHa) in the pediatric transgender patient can pause the maturation of germ cells, and thus, affect fertility potential.” As Abigail Shrier pointed out in an interview with Marci Bowers and Erica Anderson, “Patients who take puberty blockers almost invariably wind up taking cross-sex hormones — and this combination tends to leave patients infertile.”

As far as I know (and again, please correct me if I’m wrong), there haven’t been careful studies of fertility issues in young people on blockers and hormones, though I have heard from several doctors that they believe this regimen to have profound effects on fertility.

While preventing children from being sterilized is an admirable goal, it certainly seems odd to prevent procedures that will take a way a child’s right to procreate and then promote laws that take a way a woman’s right not to procreate. Could this be part of Paxton’s motivation, an extension of his desire to control reproduction in some way, to make sure that teenage girls aren’t interfered with physically so that they can go on to reproduce? Stranger things have happened. After all, obsession with the future fertility of teen girls was the basis of the 19th century tomboy movement.

It’s curious that apparently no mainstream or left outlets writing about the Texas debacle fight him on that point, other than to repeat that “puberty blockers are fully reversible,” even though the evidence for that statement is shoddy; you’ll go through your endogenous puberty if you go off them, but that doesn’t mean they don’t have lasting effects on brains or bones or one’s psyche. Because many of us on the left are so inured to the right’s below-the-belt tactics, their regressive stances on abortion and devious (and successful) attempts to control women’s bodies, we assume nefarious intent and bastardized reasoning by the right. But the really uncomfortable truth for many of us liberals is that Paxton is not wrong about some of the science he quotes, and he’s not wrong about the past horrors of sterilization wielded as a weapon.

For instance, he writes:

While the spike in these procedures is a relatively recent development, sterilization of minors and other vulnerable populations without clear consent is not a new phenomenon and has an unsettling history. Historically weaponized against minorities, sterilization procedures have harmed many vulnerable populations, such as African Americans, female minors, the disabled, and others. These violations have been found to infringe upon the fundamental human right to procreate. Any discussion of sterilization procedures in the context of minor children must, accordingly, consider the fundamental right that is at stake: the right to procreate. Given the uniquely vulnerable nature of children, and the clear dangers of sterilization demonstrated throughout history, it is important to emphasize the crux of the question you present today— whether facilitating (parents/counselors) or conducting (doctors) medical procedures and treatments that could permanently deprive minor children of their constitutional right to procreate, or impair their ability to procreate, before those children have the legal capacity to consent to those procedures and treatments, constitutes child abuse.

Procreation, he continues, is a constitutional right.

The United States Supreme Court recognizes that the right to procreate is a fundamental right under the Fourteenth Amendment. See Skinner v. Oklahoma, 316 U.S. 535, 541 (1942). Almost a century ago, the Court explained the unique concerns sterilization poses respecting this fundamental right: The power to sterilize, if exercised, may have subtle, far reaching and devastating effects. In evil or reckless hands it can cause races or types which are inimical to the dominant group to wither and disappear. There is no redemption for the individual whom the law touches. Any experiment which the State conducts is to his irreparable injury. He is forever deprived of a basic liberty.

Is Paxton anti-trans, or is he concerned about sterilizing a generation of trans kids because he believes that it’s our God-given duty to procreate? Is he worried that adolescent girls won’t be able to fulfill their procreative task? Or is he worried that kids too young to understand the lasting implications of their medical interventions are making decisions that will follow them into adulthood and which they’ll come to regret?

It’s not possible to know who will want kids and who won’t, just as it’s not possible to know who will persist in a transgender identity and who will desist. But I’ve heard stories of grown, but young, women trying to get their tubes tied and doctors not believing them when they say they know they don’t want kids. It’s so hard for any of us to sneak out from the protective cover of our own beliefs and stand beneath someone else’s. I’ve also known people who said they didn’t want kids, and changed their minds. And people who said that and didn’t change their minds. Maybe what we need to protect is the right to change our minds, and if that’s the case, one would indeed proceed with caution when it came to gender-affirming interventions.

It’s also not possible to know Paxton’s motivation, if he’s following the science or advancing a regressive agenda. It could very well be both. But our toxic political environment has kept many of us—and especially many in the media—from being able to consider the what of his words because we’re so sure about the why. If he’s really concerned with reproduction, I hope he’ll reconsider his stance on abortion. What he’s doing now is convincing more people that his motives are rooted not in science, or concern for children’s welfare, but in hate.