According to the wisdom of the day, kids experiencing gender dysphoria need to be treated affirmingly as early—and as radically—as possible. For the time being, surgery and hormone therapy have to wait until age sixteen. But before that, adolescents can be prescribed puberty blockers, and even younger children are encouraged to transition “socially,” by adopting the name, dress, and mannerisms of their preferred gender.
All of this is in spite of the fact that gender dysphoria in children sees very low rates of persistence—ranging from 2.2% to 30% in males and from 12% to 50% in females, according to the DSM-5. As Dr. Kristina Olson, a research psychologist at the University of Washington, put it, “We just don’t have definitive data one way or another.” The truth is that no one can predict whether a gender dysphoric kid will feel the same way years later. That’s why Olson is leading a study of 300 trans kids that will track outcomes over twenty years. “To be able to, hopefully, answer which children should or should not transition,” she said. In the meantime, many of those children will be encouraged to go ahead and make life-altering medical decisions in light of scientific ignorance.
Standards Are Getting Looser, Not More Stringent
The standard medical and social response to gender dysphoria is to encourage and affirm the child’s self-diagnosis and to provide hormone therapies and unnecessary social and medical gender transitions without thoroughly exploring alternative effective treatment plans.
In fact, a team of international doctors affiliated with The Endocrine Society, the Pediatric Endocrine Society, and the World Professional Association of Transgender Health—all of which are held in esteem in this field of medicine—is rewriting treatment guidelines so that a medically induced gender change may be recommended for children even younger than sixteen. This represents a huge departure from what were already lenient guidelines for treating children who feel they are in the wrong gender.
Until now, the guidelines recommended giving preadolescent children puberty blockers to give more time to decide about going forward with more invasive treatment. But under the new guidelines, the more invasive treatment of cross-gender hormones will be recommended for children younger than age sixteen. Many physical effects of hormones, such as reduced bone density and reduced fertility, are irreversible. Other risks haven’t been studied at all.
Making an Informed Decision Is Impossible
Recently an email arrived in my inbox with the subject “I wish I listened to you” from a young man who regrets taking cross-sex hormones and undergoing surgery.
I’m only in my mid [twenties]. I transitioned in my teens and had surgery. I was [too] young to make such a decision. I’ve sunken into such a deep regret. I don’t even feel transgender anymore. I feel like my old self. I am happy with a female appearance but that is all I really needed. I feel like I was brainwashed by the transgender agenda and by gender norm expectations. I would do anything to [have] my penis back. My feelings were confusing and I thought they would never go away. I’m just a guy who’s really in touch with my feminine side. I can’t believe what I’ve done to my life. And now I have no choice but to take hormones forever. I don’t know what to do. I feel like I’m losing my mind. All I would have had to do was discontinue my hormones and everything would have been alright. I honestly feel 100% normal and okay . . . if only I had never had that surgery.
This young man’s body is permanently damaged because doctors, who have no definitive idea as to who will persist in a condition of gender dysphoria, propose irreversible treatments for young people who feel conflicted about gender. But as this young man found out, even strongly held feelings change.
My own story was similar: I was a trans kid, and I underwent gender change surgery after waiting until I became an adult. Living in unrelenting gender confusion for most of my life and desiring a resolution, I took the transition path that top gender doctors recommended for me. I trusted their guidance. But that didn’t prevent the wave of regret that followed.
Firsthand accounts such as this one confirm the empirical data: no one knows who should transition or at what age, if anyone ever should. Given our inability to predict the future of children’s dysphoria, any doctor who is actively administering hormone blockers based on a child’s feelings is ignoring or dismissing the biological facts and pretending to knowledge he or she cannot have. Ignoring the science is malpractice and places the children and parents at risk of deep lifelong regret for having agreed to unnecessary procedures.
Young children are making this “decision” based on feelings, not verifiable lab tests, but children are much too young to make such a life-changing, and likely regrettable, decision. Kids and parents need to be able to trust that doctors will not play a game of Russian roulette with their lives.
Social Transition Is Not Harmless Either
Even if it’s unwise to make hormonal and surgical interventions into gender dysphoric kids’ lives, isn’t it a good idea to help them socially transition, in case they want to transition years later, as adults? No: this practice is not without serious risks either.
As Eric Vilain, a geneticist and leader of the Center for Genetic Medicine Research at Children’s National Health System, points out, social transitioning is liable to influence children’s thinking. “If the children are pushed in this belief it will be much harder for them to get out of this belief because everyone will have agreed on it very, very early on,” Dr. Vilain says. It’s one thing to grow up confused about one’s gender; it’s another thing to grow up being told that one belongs to a special group of “trans kids.”
But getting everyone—parents, siblings, fellow students—to agree that a young boy is a girl doesn’t make it so, and it doesn’t change the empirical fact that no one is able to predict which gender dysphoric children will remain gender dysphoric as time goes on. None of this is even to address the question of whether those who do persist in their gender dysphoria will find the relief they desire by transitioning. Yet children encouraged to socially transition are being placed “on a path that will have a lot of medical and surgical consequences,” and they will be all the more likely to take irreversible steps because they have been told for their whole lives that they are “trans,” that they are “really” the gender they think they are.
But—according to the most recent scientific evidence on the persistence of childhood gender dysphoria—many of these children would have grown out of their gender dysphoria on their own. Lowering the minimum age for surgery only increases the chance that kids will agree to a procedure that they will deeply regret.
Transgender children should not be placed on the path of unnecessary and irreversible medical interventions that include cross-gender hormones and body-altering surgeries. The scientific community simply has not demonstrated the long-term efficacy or studied the risks and harms being done.
In the meantime, don’t let the rhetoric surrounding this issue distract you from the fact: we are performing an experiment on our children. We will learn twenty years from now, when Dr. Olson’s study is complete, whether the doctors were wrong. So we wait.