Youth Gender Medicine Is Politically Nonbinary

An op-ed rejected by multiple major news outlets

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Last month, Shawn Thierry, a Black woman and Democratic state representative for Houston’s 146th House district, voted in favor of Senate Bill 14. The bill prohibits procedures “to transition a child's biological sex”—in other words, a ban on what’s known as “gender-affirming care” for minors. She did so, she said in a statement, for the “safety and well-being of all young people” after “hearing from constituents, listening to stakeholders, and reviewing the scientific data.”

Thierry was primaried—her seat challenged within her party—and formally censured by Democrats, who have made embracing these interventions central to their platform.

But Thierry is just one of many liberals whose views on gender don’t slot neatly into the left-versus-right narrative many progressives have come to accept: that Republicans endorse hateful, anti-science and anti-trans policies and Democrats advocate pro-trans policies that respect science and save children.

In fact, this framing is misleadingly simplistic. Some of it is flat-out wrong.

Many American liberals, including some who work in gender health care, are concerned about how gender issues are handled in schools, sports, and medicine. They disagree not only with their party’s stance, but with presenting this issue as politically binary. And they reject activists’ mischaracterization of debate and dissent as hate speech.

Psychologists Laura Edwards-Leeper and Erica Anderson publicly objected to the current affirmative model; Anderson is a trans woman, and Edwards-Leeper helped import the treatment protocol to the United States. Jamie Reed, former anarchist organizer and queer woman, married to a trans man, blew the whistle on “permanently harming the vulnerable patients in our care” at The Washington University Transgender Center at St. Louis Children's Hospital. Dr. Julia Mason, a liberal Oregon pediatrician, has spoken out, too.

They see the science politicized and misrepresented—by their own side.

Previous research on the psychological effects of puberty blockers, cross-sex hormones and gender surgeries, was based mostly on young boys with lifelong gender dysphoria, and without other mental health conditions. Now, the bulk of patients are teens, mostly girls with autism or mental health conditions, whose gender dysphoria appeared suddenly in adolescence.

Yet when researcher Lisa Littman wrote a paper about this emerging demographic, using the accepted research method of parental reports, left-leaning clinicians and politicians denied the existence of these new, complex clients. A recent paper about them was retracted after activist pressure. This even though much of Europe, which saw the same trends as the U.S., has acknowledged the new cohort in order to carefully consider the appropriate treatment for them.

England, Finland, France, Sweden, and Norway, among other countries, have also acknowledged an increase in “detransition”—regretting transition and returning to identifying with their natal sex. In the U.S., detransitioners who speak out about the harms of the permanent changes to their bodies are painted by the left as tools of the right wing, rather than victims of a protocol in desperate need of reform. Progressives often argue that transition regret is so vanishingly rare that detransitioners’ poor outcomes don’t matter.

A recent study, however, suggests that nearly 7% of those who medically transition detransition after only a year. The authors also note that regret seems to most commonly set in between 4 and 8 years. As a result, “we may have underestimated the frequency of detransitioning.”

These trends prompted several non-partisan government health agencies in Europe to conduct systematic evidence reviews—evaluating not only the studies’ conclusions about gender-affirming care, but their reliability. Each review found the evidence to be of low to very low quality, and each country concluded that for young people, the risks of puberty blockers and cross-sex hormones outweighed the benefits. Several will offer puberty blockers only in exceptional cases, and within clinical trials.

And yet, in the U.S., more than two dozen medical associations continue to claim that gender-affirming care for youth is evidence-based and even “life-saving.” Most Americans believe these associations exist to help ensure patients get good care. Not so. These associations are not nonpartisan evidence-review groups. They are advocacy organizations which protect their members, not patients. The American Academy of Pediatrics, for example, refuses to conduct a systematic evidence review. This month, the American Medical Association doubled down on the affirmative model.

Last year, the World Professional Association for Transgender Health (WPATH), a powerful advocacy organization which offers its recommendations as gender medicine’s “standards of care,” released their newest recommendations for children with gender dysphoria. All minimum age requirements for gender surgeries and other medical interventions had been removed.

Some clinicians have admitted that the new standards were designed (at least in part) to prevent malpractice suits, while American medical groups support laws which indemnify practitioners of gender-affirming care, making it harder for patients to sue when harmed.

Corinna Cohn, a self-described transsexual and advocate for better gender healthcare, told me that “The doctors are still protected, but the patients don’t have any good ability to be made whole.” Despite being libertarian and trans, Cohn testified in favor of bans on the medicalization of child gender transition in Ohio and Indiana, which are among the 18 states to have passed bans on pediatric “gender-affirming” medicine. She wants to shift the burden from patient to provider by extending the statute of limitations on malpractice suits, as some bills would.

“The bans are a result of a systems breakdown,” said Jane Wheeler, president of Rethink Identity Medicine Ethics, a nonprofit dedicated to ethical care for gender nonconforming youth. A lesbian, and former regulatory healthcare lawyer, she says the bans “are a response to a regulatory vacuum.”

Some bans do appear politically motivated, and even cruel, criminalizing parents who consent to treatments, even when following medical advice. And some result in forced detransition without considering the physical and psychological effects. 

Meanwhile, blue states also play dirty politics. To prevent Democrats from voting to end pediatric medical transition, Oregon tied gender-affirming care to abortion in its reproductive health rights bill, forcing politicians to deny women the right to choose in order to end gender-related medical interventions for children. And Democrats in both Oregon and Texas blocked amendments that would mandate that any health insurer who provides medical transition also provides detransition care: interventions like reconstructive surgeries and hormone management, which are covered only when someone transitions—not the other way around.

Some “sanctuary state” laws, like Oregon’s HB2002, allow anyone over the age of 15 to access gender-affirming medical interventions without parental consent. Washington’s SB 5599 makes it easier for kids in shelters to access gender medicine without parental consent. But no research suggests that kids who want to transition do better without their families, even if families are hesitant about or against medicalization.

Gays and lesbians are particularly concerned: Decades of research found that more than 85% of gender dysphoric children came to accept their bodies after going through puberty. Around two thirds of those grew up to be same-sex attracted. Children’s own puberty, as distressing as it may be to those suffering from gender dysphoria, seems to provide a natural resolution—as long as those children are neither socially nor medically transitioned. The affirmative medical protocol, on the other hand, interrupts that natural resolution of puberty, using the same drugs once used to “treat” (or punish) homosexuality.

There’s no doubt that some young people are happy they’ve transitioned. But neither is there doubt that some young people have been gravely injured. Cost-benefit analysis is the backbone of good health policy, but one side ignores the benefits, and the other, the costs. When research is politicized and filtered through a left-right lens, we can’t see clearly.

In this culture war, young people are the collateral damage.

(Thanks to Pamela Paresky for this excellent title.)