What If We Used Different Words?

On the language of gender-affirming care

Creative Commons/Wikimedia

If you’ve been reading this newsletter for a while, you know that I find both red and blue state legislation on youth gender medicine, well, bonkers. But I often hear from readers that there’s no comparison. “Bans” on gender-affirming care for minors are in effect delays, requiring that young people be 18 to partake of it—the minimum age to vote or join the military. And since multiple evidence reviews have declared that gender-affirming medical interventions don’t quality as “life-saving” care—though I do know people who experienced them that way—delays could be construed as reasonable, some readers say, instead of malicious.

The problem is that delaying care makes it harder for young people to “pass” as the opposite sex—this was a big reason the Dutch started to experiment with puberty blockers and early administration of cross-sex hormones in the first place. (This contributes to my continuing suspicion that gender-affirming care actually decreases our understanding and acceptance of gender nonconformity.)

But there’s no talk of passing in the current discourse. Instead there’s talk of saving kids from suicide—talk that in itself is (dare I use this word?) problematic because journalists and medical professionals have a responsibility to report about suicide in a very specific way, so as not to cause social contagion. And the suicide statistics are simply not reliable or accurate. As Emily Bazelon recently reported in The New York Times magazine, deaths by suicide among trans-identified youth are “fortunately rare,” and “occur during every stage of transitioning.” Rates of suicidal ideation and attempts (very different from deaths) are high, but similar to those of kids with other psychiatric conditions.

So how would this debate be different if “life-saving care” could no longer be used, even if for some adults transition really did drastically improve their lives? Or what if we said “elective gender-based cosmetic interventions” instead of the slippery and ill-defined “gender affirming care?”

Language is such an important part of this debate, or, rather, this fight. We fight over the word woman, and who gets to claim it. We shift language to be more gender-neutral and inclusive, or as some see it, to erase sex-based rights. Gender identity disorder morphed into gender dysphoria in the DSM in 2013, which depathologized the desire to look like or live as the opposite sex but still allowed patients to have their interventions covered by insurance. That is now changing to gender incongruence, which makes the condition seem medical, rather than psychological, which could bolster the case for more medicine, less therapy—the opposite, as I wrote last week, of what’s happening in several European countries. Gender identity disorder, by the way, was only added to the DSM in 1980, after homosexuality was removed in 1973.

Language matters. I understand why meanings change, why we say, for instance, “enslaved people” instead of “slaves” now—to emphasize the humanity of those people whose freedom was robbed; they were more than just slaves. They were people, forced into slavery.

But when it comes to the language of gender-affirming care for young people, some shifts have worked to obscure the reality or the severity of these medical interventions. If we referred to medical and social transition for minors as childhood sex changes, for instance, I’m not sure how many parents would feel comfortable partaking of or supporting them. So while the language shifts work to normalize and destigmatize these treatments for those who might benefit from them, they also might prevent people from understanding them. And when the media reports on these treatments, or the laws around them, in a one-sided way, that obfuscation is magnified.

What if, for instance, we called the bans “delays?” Or, as my friend Pamela Paresky recently said, what if these red state laws were described as “putting the pause button on transition,” the way puberty blockers are described as “putting the pause button on puberty?”

Might there be less upset from the left around these laws if the language changed? (For the record, I’m anti-ban, but I do support the calls for non-partisan evidence reviews and a neutral party to create evidence-based guidelines for care, as well as extending the period of time in which young people can sue for malpractice; I support, you know, high-quality care for gender dysphoria.)

What if, instead of calling these bills “anti-trans”—as the left and mainstream media baldly do—they were called “pro-child safeguarding” or “pro-women’s rights?”

What if, instead of using the term “trans kids,” we said, “children with gender dysphoria?” Or what if we used “young transsexuals” instead of “trans kids?”

What if, instead of “bans on trans women in sports,” we said, “legislation to require same-sex sport participation?”

What if “gender-affirming surgeries” were “adolescent sex change surgeries?” What if “top surgery” was “double mastectomies?”

What if “social transition” was “treatment to increase persistence and likelihood of medicalization?”

What if there was no silent pressure not to discuss detransition? What if we regularly told those stories so that parents of and kids with gender dysphoria understood the full landscape, so they could make the best and most informed decision about how to respond to their condition?

But organizations like the Trans Journalists’ Association urge media outlets not to tell the full story. Their style guide makes the following suggestions:

· avoid giving a platform to TERFs or so-called “gender critical feminists”   
· avoid disinformation on “rapid onset gender dysphoria”
· do not emphasize detransitioning or report disinformation on those who stop transition-related care

In other words: don’t tell multiple sides of the story. Ignore the newly emerged cohort of teen girls with comorbidities, and don’t talk about detransitioners. Sweden and Finland did pay attention to the ROGD cohort and to detransitioners, because they were seeing them with their own eyes, as many Americans are, too. But in Sweden, the state media told their stories, and the medical community responded to data. Here, the mainstream media is following the TJA’s advice. They debunked ROGD, ignored or impugned detransitioners, and didn’t give left-wing critics a voice. They accepted the new terminology without scrutinizing it, and the American public is poorly informed because of that.

These censorious ideas are powerful. I once got this note on a story for a major media outlet where I dared to use the word detransition: “The notion of whether ‘regret’ is an accurate way to characterize those who detransition is a fraught claim.” I ended up taking the word—and thus, the idea—out.

The term “gender-affirming care” is vague, perhaps deliberately so. According to this article, the term “affirmation” came from parents of feminine boys who wanted to remove the shame and stigma they regularly experienced, to tell them they were fine as they were. But soon parents of feminine boys were outnumbered by parents of what were then thought of as transsexual girls. And affirmation became about identity, not behavior.

That in itself is a story. I would prefer if we use the most precise language at our disposal to tell it.