Over at “GenderReport.ca”, we find this steaming pile of verbal dung: “How Gender Ideology Imposes A Dangerous Political Agenda In Our Schools”.
As is common with such articles, it is deliberately alarmist, designed to terrify people, not inform. In particular, it treats the concept of “gender ideology” as a given, while never actually providing a meaningful definition of it. In other words, like a lot of these articles, the term has become something of a “straw man” which the reader is then encouraged to direct their fears and worries into.
What is “gender ideology”? In today’s right-wing discourse (which is pretty much the only place you will see the term in active use), it pretty much boils down to anything that involves recognizing transgender identities as real and valid, any steps taken to acknowledge transgender people’s legitimate rights to move through society safely. They throw in a nice dash of “predator fear” for flavouring, and then dump it about in great quantities. It’s the intellectual equivalent of cheez puffs - lots of volume and energy, no real substantive value.
Where schools are concerned, we get the “protect the children” nonsense rolled out, with claims made that children are too young to understand this stuff, and therefore “Gender Ideology” is harming kids. They go on to argue that social contagion (aka “Rapid Onset Gender Dysphoria (ROGD)” - debunked over here) is going to cause their kids to be forcibly “transed” (sic - their term, not mine) by schools and doctors.
Pay close attention to the wording of this last sentence here. It is loaded with misconceptions, misunderstandings, and generally false ideas about what transition means, the nature of medical treatments involved, and the ability of trans people of any age to understand and consent.
First, let’s talk about the notion of “highly experimental surgeries”. Male to Female gender reassignment surgeries have been around since the 1950s (and arguably sooner than that by some accounts), and in many ways are really little more than a variation on the seemingly less controversial surgeries performed on intersex children. Female to Male genital surgeries are newer (60s or 70s, I think), but any surgery that’s been around that long is hardly “experimental” at this point. Likewise, hormone therapy has been around since before the 1950s, and puberty blockers have been actively used to treat precocious puberty since at least the 1970s - hardly “experimental” in any meaningful sense of the term. The risks and consequences are well documented and well understood.
As for “taking pills for the rest of your life”, I challenge anyone over the age of 40 to look at their medicine cabinet and the prescriptions that they get refilled every few months. Kids who have asthma often require inhalers for the rest of their life; Type 1 diabetics often need insulin for the duration of their lives, and so on. I’m not seeing a major issue here.
Let’s talk briefly about the developmental issues that get raised - namely that “kids are too young to understand”. First, this infantilizes students who go through some of the most significant stages of development while in school.
By the time a child is in grade 1, we already expect them to understand “boy” and “girl” - and frankly the vast majority do. Who is to say that a grade 1 child cannot also understand the idea of “I have a boy’s body, but I don’t feel like a boy”? In fact, when you talk to a lot of transgender adults, stories of being aware of the incongruence of their body, the social cues they were getting, and how they felt internally is common, with awareness of being transgender happening somewhere between pre-school age and the end of elementary school. Whether they had the language to express that or not is irrelevant.
If the boy that was Johnny is grade 1 comes back the next year and is going by Jane, with long hair now, that’s simply not a problem. We know from experience that most of their classmates will shrug and carry on as normal. Children are, at this age far more flexible than their parents often are.
Middle School (or Junior High as it is called here), is the point in time when most kids go through puberty. Anyone who doesn’t think that transgender youth don’t understand what’s happening to their bodies has never talked to a transgender youth. It is not uncommon for transgender youth to find themselves painfully isolated, both physically and socially at a time when social development is just as important as what’s going on in the body.
By high school, the damage is done for many trans youth, and they’re hanging on until they can transition as adults, free from whatever strictures their parents may have imposed. You cannot tell me that by their teenage years a person is incapable of understanding gender both in physiological and social terms. If you’re going to argue that, then I’m going to ask how it is that person is deemed able to work, operate machinery, and ultimately vote?
What about those for whom “it’s (trans identity) is just a phase?”. Sure, there’s going to be some of that. That is why in general irreversible treatments don’t happen until the individual is old enough to understand the consequences of their decision (mid-teens for cross-sex hormones, and 18 or so for surgeries). Puberty blockers are reversible, and are used as an instrument to buy the person time to experiment and adapt socially without experiencing the often traumatic experience of “the wrong puberty” - and trust me, unwinding that experience as an adult is brutally painful work in therapy.
I will refer you to the following editorial which provides an intelligent, clear-headed overview of why gender affirming care - including recognizing transgender identities in schools - is so important. I won’t bore you with a ton of academic papers which also support that position. Suffice it to say that a few minutes with a decent academic search engine turns up plenty of evidence that supports the author’s claims.
This is a particularly sly bit of sleight-of-hand. Suddenly we go from “gender ideology” to “woke”, so the author can pivot to complaining how recognizing a student’s gender identity in class is somehow an infringement on their right to disagree. We’ve heard this before, from Dr. Jordan B. Peterson (Dr in that he holds a PhD, not that he has any medical expertise). The problem with positions like this is that it is basically telling the students that “as your teacher, I know you better than you know yourself”. This is arguably backwards to begin with, but it’s particularly offensive when you are in fact condescending to the students in your classroom.
As for scrutiny, it’s next to impossible to “scrutinize” a position like this when the concepts of “gender ideology” are not grounded in reality to begin with. Instead it is a mashup of random fears and claims by people who clearly have little or no direct experience with transgender people, their needs and concerns, and the realities of treatment they face. It is one thing to be concerned about something you don’t understand, it is quite another to use those “concerns” to try and erase an entire segment from society because they “scare you”.
On a closing note, I encourage all of you to go read the article “Bathroom Battlegrounds and Penis Panics” for a clear-headed, social perspective on all of this.
5 comments:
"Primum non nocere," meaning "first, do no harm," is fundamental to medical ethics. The principle of non-maleficence, which is derived from this maxim, states that, "given a problem, it may be better not to do something, or even to do nothing, than to risk causing more harm than good."
The case for gender-affirming care is presented as a way to prevent suicide, often crudely put as "better a live boy than a dead girl." If we’re so certain that denying kids access to puberty blockers and cross-sex hormones will lead to suicide, then shouldn’t there have been a lot more pediatric suicides in the past, before giving these drugs became standard practice? That's not the evidence we're seeing.
On a more-good-than-harm analysis, though, even a small drop in suicides is worthwhile if the risk of harm is low. So what are the costs of gender affirming care? All surgery comes with risk of serious injury, including death. All drugs come with side effects; puberty blockers and cross-sex hormones are no exception. According to the best available evidence, "Puberty blockers are known to affect bone and, possibly, brain development. They put users at risk of developing osteoporosis and are associated with reductions in expected IQ. They are described as ‘buying time’ for adolescents to make up their mind about whether to proceed with transition. Long-term effects are not known, but infertility appears inevitable when cross-sex hormones are introduced shortly after puberty blockers. Loss of sexual maturation will also be associated with lack of adult sexual function, although it is unlikely that a pre-pubertal child can truly understand this side-effect at the time of consent." https://www.cambridge.org/core/journals/bjpsych-bulletin/article/sex-gender-and-gender-identity-a-reevaluation-of-the-evidence/76A3DC54F3BD91E8D631B93397698B1A
Side-effects that include lack of sexual function are in no way minor, especially since introducing cross-sex hormones shortly after puberty blockers is standard. Indeed, 100% of adolescents were treated this way at Tavistock, the UK's biggest gender clinic.
This all makes it hard to refute the critics who think this care is causing more harm than good. After looking at the poor evidence for reduction in suicidality and the significant risk of harm, European countries once at the forefront of gender-affirming care, including Norway, Finland, Sweden, France and the UK, have sharply curtailed such care to minors. Gender-affirming care has the makings of one of the greatest scandals in medical ethics, and North American medical bodies continue to pay lip service to evidence-based medicine while refuse to practice it - even here in Hamilton, ON where the concept was developed. https://www.wsj.com/articles/trans-gender-affirming-care-transition-hormone-surgery-evidence-c1961e27
Time to stop lying to kids that it's possible to change sex. Medicine offers only a poor immitation of sex organs and a lifetime of regret.
“First, do no harm” is not a simple black-and-white statement. All medical treatments have risks, consequences, and undesired side effects - including taking aspirin. The job of practitioners is to weigh those aspects off against each other to determine whether a given path of treatment does more for a given patient than the harm it will cause.
As an example, consider both chemotherapy and radiation therapy for cancers. The list of side effects and long term consequences of those treatments is huge, _AND_ there is no guarantee in any given case that they will be successful. For example, some forms of chemotherapy are associated with the onset of cognitive decline, and as my mother’s oncologist put it to me during her treatment: “basically we hope we kill the tumour off faster than the chemo kills the patient”. So yeah - what a choice - take a borderline lethal cocktail of meds in hopes that it kills the cancer before it kills you, or the cancer kills you.
Turning back to treatment of transgender youth in particular, there are major ethical considerations to be made that weigh the individual person’s mental health in both the short and long term off against the consequences of a particular treatment path (also short and long term consequences). Adolescent and teenage years are a pivotal time in any person’s development, both physically and socially.
We know from experience that in general, those who are able to transition before going through “the wrong puberty” have generally positive psychosocial outcomes, and do not experience the kinds of long term distress and discrimination that those who transition as adults experience. Yes, there are consequences in other areas, and it is very much the responsibility of the care team to assess the ability of the individual patient to understand those consequences and weigh that in the decisions related to treatment. None of this is easy work. / ctd
You characterize Gender-Affirming Care as though it’s a railroad process from a child’s declaration of a desire to transition to a host of medications and surgeries being rushed into the picture. Nothing could be further from the truth. A careful review of the most recent version of the WPATH Standards of Care document makes it abundantly clear that caution should be exercised, and that treatment teams need to provide “off-ramps” throughout the process. As the BJPsych article you linked to points out, treating transgender people is complex, multi-faceted, and non-trivial. This is an evolving field, and it will continue to do so. Approaches to treatment have changed enormously since the days of the first conferences that would result in the formation of the Harry Benjamin International Gender Dysphoria Association (HBIGDA) - now known as World Professional Association for Transgender Health (WPATH), and it continues to evolve.
There are ongoing questions around so-called “desistance”, especially in youth. The construct is poorly defined in literature, and more confusingly, researchers like Cohen-Kettensis have found that quite a number of people who “desist” as adolescents return to the gender clinics as adults. This raises any number of issues around the construct, including whether the individual actually “stopped wanting to transition” or was it a case of not feeling safe to assert that need either at home or in their social community?
Comorbid mental health concerns that accompany transgender identities are often complex and take years to sort out beyond the actual process of transition. In my experience, those issues deserve to be treated alongside gender dysphoria, not to the exclusion of it. Few people’s symptoms are sufficiently decoupled from each other that they can be treated in isolation from gender dysphoria. A person with gender dysphoria may be suffering from generalized anxiety, of which gender dysphoria is a contributing factor, but is not the whole picture. We can’t treat someone’s anxiety about going to the mall as separate from the gender dysphoria because chances are very good that the incongruity of how they are treated by people at the mall with how they feel about themselves is as much a factor as the sheer presence of a crowd of people.
Citing debacles like what has apparently happened at Tavistock in the UK really doesn’t demonstrate what you think it does. The UK NHS set up Tavistock decades ago, and tried to funnel every trans person in the country through it. Needless to say, Tavistock was rapidly overwhelmed, and the trans community has been pointing out the problems for decades now (I started hearing about problems at Tavistock back in the 90s). The failings at Tavistock are rightly placed on the politicians who refused to ensure that the NHS had the funds and mandate to size the program to meet the need for it. Ontario had similar issues when the Clarke Institute for Psychiatry (now CAMH) had the only gender identity program in the province. These are matters not of professional ethics, but of politics, policy, and program design.
Lastly, citing a letter in the WSJ really isn’t the great smack down you think it is. Gender Affirming Care doesn’t exclude the role of mental health professionals, and implying that it does is fundamentally misrepresenting it. What has changed over time is the nature of the role of therapists in that context. Not all transgender people need (or want) regular contact with a therapist, and they successfully navigate their way into the world in their preferred gender role. Obviously, when working with youth, the issues around comprehension, consent, etc. are much more complicated than those experienced by adults in transition, and families should be encouraged to seek out counsellors to support them through the process, regardless of the ultimate direction taken by the patient. The role of mental health professionals in the process has been well documented all versions of the WPATH SOC that I am familiar with, and it is backed up by plenty of clinical evidence and research.
However, one cannot treat this as dichotomous. Working with transgender people is an interdisciplinary matter, and one that requires the expertise of many disciplines for success. Simply saying “you just need therapy” while withholding medical interventions that would alleviate aspects of the distress that the person is experiencing is horrendously unethical too.
Lastly, I leave you with the general comment that in terms of transition, and in particular medical transition, in spite of all the hype around detransitioners lately the general outcomes are regret rates lower than those for surgeries like hip replacements.
* I do not say this last part to suggest that detransitioners should not be supported - far from it. Gender journeys are long, complex experiences and those who choose ultimately to return to their birth-assigned role are just as deserving of support and encouragement as those who choose to transition and stay.
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