Mick Hartley

This opinion piece from Pamela Paul appeared in the NYT on Friday. By UK standards it's pretty mild, but coming out with this kind of gender-critical stuff in the US is a big deal. The Cass Report has been either ignored or criticised as some kind of right-wing hit job over there, while gender ideology is official policy.

In U.S. Gender Medicine, Ideology Eclipses Science. It Hurts Kids. 

The Biden administration has essentially ceded the issue to the progressive wing of the Democratic Party, incorporating gender-affirming protocols into Department of Health and Human Services policy. Moreover, recently leaked emails indicate that President Biden’s assistant secretary of health, Dr. Rachel Levine, a pediatrician and transgender woman, successfully pushed WPATH to remove age requirements from its guidelines for gender medicine before their publication, because — mixing political and public health concerns — she thought supporters of gender treatment bans might cite them to show that the procedures are harmful. (WPATH’s draft guidelines had originally recommended age minimums of 14 for cross-sex hormones, 15 for mastectomies, 16 for breast augmentation or facial surgery and 17 for genital surgeries or hysterectomies.)

So, the state of affairs now:

America’s current policies are based on transgender advocates’ belief that all people have an innate sense of their “gender identity” irrespective of their sex. Sex, according to this belief, is merely “assigned” at birth, whereas a person’s chosen gender is the primary determinant of one’s true identity.

In this view, it is society’s and medicine’s job to affirm the gender that children say is theirs and to help them to socially, medically and sometimes surgically align their bodies accordingly. As advocates often put it, children know who they are.

Gender-affirming care can include social transition (allowing kids to change their name, appearance and pronouns, for example, in schools and other public settings), prescribing medicine to stall puberty and administering cross-sex hormones. The off-label use of puberty blockers is intended to give children time to think about their gender before their bodies go through sexual development. If they proceed with cross-sex hormones, their bodies, particularly if they’re male, can then more closely resemble that of the opposite sex. Surgery, including mastectomies, facial reconstruction and removal of male genitalia, is a possible final step.

Any effort to question or slow this process for a minor diagnosed with gender dysphoria or distress, or to treat a child’s anxiety or depression first, is often denounced as gatekeeping — preventing children from living out their true identity. Such efforts, activists believe, are attempts to reduce the number of visible trans people.

Instead of accepting normal gender nonconformity in kids (e.g., effeminate boys and tomboy girls) — and perhaps an early sign of same-sex attraction — advocates of gender ideology are more likely to view it as an indication of probable transness.

All of this frames gender treatments as ethically and medically necessary.

Put so bluntly, the sheer insanity of it all is obvious. This isn't science; it's ideology. And thousands of kids' lives are being ruined.

Already the gender-affirmation model is taught in leading medical schools, and all the major professional medical organizations in the United States have officially embraced it in their guidelines, a fact often cited by advocates as evidence of their validity.

This wholesale adoption of gender-affirming care is also a result of the differences between a centralized public health system like Britain’s and a privatized, diffuse health care system like ours. “Doctors are paid for each intervention, and thus have an incentive to give patients what they ask for,” The Economist noted in a recent editorial urging the United States to catch up with recent developments in gender medicine.

Given how entrenched the gender-affirmating model has become, reversing course won’t be easy. If the medical profession turns away from the notion that transitioning young people is necessary and lifesaving, it could open itself up to malpractice suits. Consider that in Britain, a lawsuit by a gay girl named Keira Bell against Britain’s leading gender clinic instigated the investigation that led to the Cass Review.

“I’m already hearing from the boards of directors and trustees of some hospital systems who are starting to get nervous about what they’ve permitted,” Erica Anderson, a former president of the U.S. Professional Association for Transgender Health and a transgender woman, told the British Medical Journal in May. In recent years, a number of detransitioners in the United States have brought suit charging malpractice or the failure to provide informed consent. If American doctors admit their approach was wrong, it’s going to be a costly and politically explosive practice to undo.

Yep.

It’s bound to be hard for many Americans to reconsider what they’ve heard for years as being settled science and a proven path of treatment, especially for a group that has faced considerable prejudice and political attack. Most people truly want to do what’s best for kids who are in any way suffering.

But there is no basis to rush putting kids on an irreversible path of medicalization. With children’s health and well-being at stake, effective, evidence-based and compassionate health care must be accepted. It’s one thing to pursue a medical path not knowing whether it’s effective; it’s quite another to persist on that path with no solid evidence to support it.

Despite the personal or professional costs to admitting its errors, it is time for people in the American medical and political establishments to open their minds and listen to those doctors who have fully examined the evidence.