Is gender-affirming care safe? Is it effective?
You are the parent of a young boy who is deeply unhappy because he feels that he is a girl. As your child has grown you have watched him become depressed. He has engaged in self-harm, and has few friends because his feminine behavior alienates him from his age peers. He isolates himself in his room. You are increasingly desperate because you don’t know how to help.
Until recently there were few options for your child. But today there is an industry of medical professionals, counselors and political activists who advocate for a radical solution. It is called gender-affirming care. Across the country, medical professionals have opened clinics that will evaluate your child. If your child meets a number of psychological criteria, they will enroll him in a program to physically alter his body to make him conform to the gender opposite of the one he was assigned at birth.
As drastic as this appears, you are reassured. After all, a number of professional organizations support some form of gender-affirming care. These include prestigious societies such as the American Academy of Pediatrics, the American Medical Association, the American Psychological Association and the American Psychiatric Association. According to the well-respected journal, Scientific American,
…. data from more than a dozen studies of more than 30,000 transgender and gender-diverse young people consistently show that access to gender-affirming care is associated with better mental health outcomes—and that lack of access to such care is associated with higher rates of suicidality, depression and self-harming behavior.
There are also many voices, including those of researchers and medical professionals, who express concern about gender-affirming care. A small number of studies shows that use of hormone blockers (which are often administered to minors in gender-affirming care clinics) is associated with IQ deficits and osteoporosis. In addition, the recency of gender-affirming care means that there is a dearth of evidence about its long-term effects.
Is gender-affirming care safe? Is it effective in supporting the mental health of children and the adults they become? Are patients who receive gender-affirming care in their younger years satisfied with their decision in the long run? Advocates and opponents each cite evidence that supports their side.
Gender-Affirming Care Controversy
Today there is limited controversy about adults who decide to change their gender. But there is heated debate about changing the gender of children.
Are children sufficiently mature to know what they want and to make a potentially irreversible decision that will determine the rest of their lives?
Some have argued that this decision should wait until the child matures into adulthood. But that could turn out to be a mistake because once children reach puberty their bodies develop in ways that are irreversible. These changes include bone structure, lack of breasts, and innumerable other physical characteristics. Waiting too long will impede or prevent children from becoming the gender they want to be.
Gender-affirming healthcare workers have a solution for this dilemma: hormone blockers. These are powerful drugs that freeze the body’s gender development. The intent here is to postpone puberty in order to allow children to make a decision about their gender when they mature.
When the child is ready to proceed with a gender change, doctors may administer hormones appropriate to the new gender. Intervention may also involve depilation, breast enhancements, and procedures to alter the appearance of external genitalia. Generally, surgeries must wait until the patient is 16 years old or older. Some patients choose to skip surgical options and content themselves with assuming the role of the opposite sex to all outward appearances.
The emergence of gender-affirming care has triggered an avalanche of public opinion both for and against. As of this writing, a few states in the US have prohibited or limited this type of care for children. On the other side, a number of advocacy organizations have entered the political arena to “protect the right to gender-affirming care.”
Is There an Alternative to Gender-Affirming Care?
There are similarities between today’s attitudes about gender dysphoria and attitudes about homosexuality prior to the 1970s gay rights movement.
Prior to 1973, the Diagnostic and Statistical Manual of the American Psychiatric Association listed homosexuality as a mental disorder. The perception at the time—-among the public as well as medical professionals—-was that homosexuals were deeply unhappy, depressed and unable to form stable long-term relationships. Many argued that homosexuals were a threat to society. Popular depictions in movies and novels portrayed homosexual characters who inevitably committed suicide or met other tragic ends. Most people said that homosexuals were in need of treatment in order to conform to heterosexual norms. These treatments came to be called conversion therapy.
Today these ideas seem outdated, even cruel. In many states, laws prevent licensed mental health professionals from administering conversion therapies to change the sexual orientation or gender identity of minors.
Most people today believe that homosexuality is a benign variation in human development. Medical professionals are likely to counsel that homosexuals and those around them should learn to accept the individual’s homosexual identity. Political advocacy organizations today stress the need for education so as to minimize public lack of acceptance and prevent discrimination and prejudice. In many parts of the country, laws prohibit discrimination against homosexuals.
The Lessons of the Gay Rights Movement Applied to Gender Dysphoria:
What if we abandoned the push to change the gender of adults and children who feel they were born into the wrong body—-just as we earlier abandoned the push to change homosexuals into heterosexuals? That means that medical professionals, parents, and advocates abandon the use of surgery, hormone blockers, and hormones for gender dysphoric people.
The lessons of the Gay Rights movement suggest a two-tiered approach to gender dysphoria. The first tier is psychological intervention with gender dysphoric people to enable them to feel good about who they are, just the way God made them—–their bodies, their feelings and the way they present themselves to the world. The second tier is an effort to enlighten public attitudes toward gender-dysphoric people. The goal here is to reduce public rigidity about gender identity so that people who don’t fit the traditional gender mold will be cherished for who they feel themselves to be. This will go a long way to alleviate discrimination against this group.
In learning to accept gender dysphoric people for who they are, we might just create a more humane society for everyone.