There Will Be No Heroes
Are clinics, and the media, righting the ship? Is this the reckoning?
Last week, a parent told me that she’d taken her child to a gender clinic which had, in the past, fast-tracked kids with gender issues toward puberty blockers and cross-sex hormones. She was pleasantly surprised when the intake counselor assured her that they take a “conservative” approach, and carefully evaluate children before sending them down a medical path. She was relieved—maybe her child would get decent healthcare after all.
Another parent wrote to me that he’d asked the school counselor in his ultra-blue state middle school not to change his child’s name and pronouns without his knowledge or consent, even though school guidelines mandate school personnel to do so. The counselor agreed, and seemed sympathetic as to why this might be important—that is, she recognized that triangulating between parents and kids might not be in the child’s best interest.
Could it be that, now that two detransitioners have filed lawsuits, gender clinics will start practicing carefully? Could it be that hospital doctors and counselors, looking at the backlash fomented by right-wing coverage of the issue, are making sure they proceed more responsibly—otherwise known as CYA*? Or could it be that they are watching what’s happening in other countries, and shifting because they think it’s best clinical practice? Could it be that schools will stop treating parents as enemies that must be kept at bay? Will kids who may truly benefit from transition finally get the full information for informed consent, so that they and their parents can make better decisions?
Are we seeing signs of self-reform?
The New York Times story that ran earlier this week might help some practitioners understand why that’s important, and feel safe to pull back on the affirmation-only model. It was, to the shock of many, an actual balanced piece that admitted the many things I and a select few other journalists have been pressing them on, and reporting, for quite some time. Puberty blockers “have become the first line of intervention,” they admit, but have not been proven safe and effective due to “little documentation of outcomes and no government approval of the drugs for that use, including by the U.S. Food and Drug Administration.” We don’t know how to weigh the risks and benefits because we don’t have enough good research or long-term data. For some young people, the physical drawbacks have been worth the cosmetic physical changes and the psychological shifts. For others, they’ve been a grievous mistake.
The reporters show us just how young medical interventions begin: “Many physicians in the United States and elsewhere are prescribing blockers to patients at the first stage of puberty — as early as age 8 — and allowing them to progress to sex hormones as soon as 12 or 13.” That’s important, because we often hear that children aren’t being medicated. I think 8-year-olds qualify as children.
There were plenty of problems with the article, including the framing that “Transgender adolescents suffer from disproportionately high rates of depression and other mental health issues.” We don’t know if adolescents with high rates of depression tend to develop gender dysphoria, or if gender dysphoria causes high rates of depression, and it’s important to be clear about that. They note that “Studies show that the drugs have eased some patients’ gender dysphoria—a distress over the mismatch of their birth sex and gender identity.” But those are the studies systematic evidence reviews have deemed low or very low quality—that is, the outcomes may not hold beyond the confines of those studies. They note that the rise in teens identifying as trans has been “fueling government reviews in Europe.” But they don’t mention those those “government reviews” include the kind of systematic evidence reviews that the American Academy of Pediatrics and the World Professional Association for Transgender Health have refused to do.
My other criticism is harder to articulate. It’s about the way the media and medical establishments use the word transgender when it comes to kids. “Puberty can help clarify gender, the doctors say — for some adolescents reinforcing their sex at birth, and for others confirming that they are transgender,” the authors of the New York Times piece write. It’s important to acknowledge, as they almost do in this piece, that puberty has historically been the time when most young people reckon with their sex, and eventually overcome gender dysphoria; that is, puberty has been the best path for the resolution of GD, and puberty blockers may disrupt that natural resolution.
These days, transgender can mean different things, from someone who has a gender identity different than sex to someone who doesn’t conform to stereotypes. Plenty of people identify as trans without desiring medical interventions, and not everyone with gender dysphoria transitions to become trans. We have a fundamental terminology problem. So I think we should use the word transgender to refer to children who transition, psychologically or medically. If that were the case, the authors would say that puberty might clarify for someone that they really do want to transition. It’s a small point, but, I think, an important one, because it shows that transition is a strategy, a choice, a response to anything from gender dysphoria to trauma to sexual orientation. There’s still a lack of understanding, or curiosity, about the source of gender dysphoria and how best to treat it.
What’s remarkable about the article is that it makes no reference to the paper’s previous articles that presented puberty blockers as safe and fully reversible, asserting that only Republicans objected to their use, while medical experts agreed they were appropriate. Had the writers of those articles simply interviewed the many medical professionals speaking up for years now, instead of dismissing them as bigoted, we might have arrived at this piece a long time ago.
For those of us who’ve been trying to deliver this message through mainstream channels—some for years, and in my case, a year-and-a-half—it’s a little frustrating to see this information presented as some kind of new revelation. But mostly it’s a relief. It signals to other outlets that they’re allowed to present dissent as rooted in science, not hate. So perhaps this is the moment many of us have been waiting for, when the media will embrace the mission of reporting honestly, even when it is politically inconvenient to do so.
Several people sent me the piece and suggested that I and others who’ve tried to tell this side of the story would be exonerated. Are those who’ve been sounding the alarm and trying to tell a more complicated story for much longer than I have finally going to be able to rip the scarlet letters from their lapels and say they told us so? Or will the media simply start reporting a new story, with no nod to the reality that they weren’t before, no mea culpa, no acknowledgement of previous misinformation, and no acknowledgement of the costs—the bodies and psyches truly hurt by a medical practice overwhelmed by ideology over science, unwilling to see the costs, only the benefits?
Corinna Cohn, a transsexual (as she calls herself) who co-founded The Gender Care Consumer Advocacy Network to advocate for better health care for people with gender distress, thinks the latter.
She wrote to me:
“At some point the public perception of medicalizing children will stabilize around the idea that hormones and surgery should be prohibited for children. When that happens, it will be due to the efforts of journalists, academics, parents, and activists who will have lost friends, been fired from jobs, and have lost opportunities for professional development because they had the audacity to speak up on this issue. There will be no celebrations, and there won’t be any heroes of the movement. The people who quietly supported medicalizing children will silently change their positions, and we’ll all carry on like it was always this way. Those who are making sacrifices now are doing so selflessly, because there are no personal rewards for this work.”
That is: There will be no public reckoning, no vindication of those defenestrated by the narrowed Overton window. Those who’ve suffered damage to relationships and reputations won’t be vindicated.
It is, of course, far more important that consumer gender medical care is properly evaluated than it is for those of us who’ve lost something—friends, work, social standing—to regain our footing. But it’s still a sad prediction. When the Satanic Panic turned out to be a mass hysteria, there were no media mea culpas then, either. They simply pivoted to tell a new version of the story. Perhaps it’s no wonder that trust in the media is at an all-time low. But I guess the question is: If we don’t really reckon with what happened, if reform is on the down-low, how will those who’ve been hurt fare? How will we prevent such mistakes from happening again?
I heard one other thing from parents this week that really struck me. A couple from South Carolina told me their state is trying to pass copies of what are often called “anti-trans” bills in other states, which require kids to play in sports according to sex, not gender identity, or prevent teachers from discussing matters of gender and sexuality to young kids, as well as restricting gender medicine for those over 18. I oppose bans because a) I don’t want the government making those decisions and b) I think they get in the way of desperately needed reform. But there’s another reason: They solidify fear and hatred of kids who identify as trans, turning a feeling into a policy. She told me that many adults in her state, who have no experience with trans people at all, consider them the devil, and will do anything to keep trans identification outside the realm of possibility for their kids. That is utterly horrifying.
As I’ve said many times, this movement, this idea about gender identity—I don’t believe it’s creating more understanding of gender diversity. Each side is so extreme that these kids who are genuinely in the middle, genuinely gender diverse, aren’t accepted as themselves by either. But the strong-arming Republicans are reacting to Democratic overreach. So it is up to the liberals to right the ship, to moderate, to modify. Is it happening? If they do it on the sly and we don’t see it, does it count? Big ifs, I know. In the meantime, I’m glad to see the mainstream media doing a better job.
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*Cover Your Ass, if you don’t get this reference.
I’ll admit Lisa, I was pretty irked that this will be seen as some new revelation by the NYT and the article’s author/s. I so wish you were getting the recognition you deserve, publicly and monetarily.
I too am heartened by the fact that the NYT published this article. And while the lack of acknowledgment of previous mis-reporting (or non-reporting) is frustrating, it’s hardly surprising.
My bigger concern, though, is that many readers may come away with the idea that the biggest issue with puberty blockers is physiological side effects (e.g., on bone density) and so it’s just a question of trade-offs and/or mitigation (calcium supplements!). There’s only passing mention of the idea that puberty blockers end up being a “gateway drug” to cross-sex hormones, and that being allowed to go through natural puberty would likely cause the resolution of gender dysphoria in the vast majority of these kids. But I guess that’s still a bridge too far for the NYT. Baby steps...