Take a moment and consider the phrase "trans child". What does that mean exactly. What defines a trans child separately from a child? The current clinical practice for trans children promoted by the Endocrine Society and other major medical associations centers gender affirming therapy. This is a protocol focused "
on affirming a patient's gender identity and does not try to "repair" it." The protocol may begin with puberty blockers at 14, cross sex hormones at 16, and sexual reassignment surgery starting at 18. In essence, if a child feels like she was "born in the wrong body", the protocol is to halt puberty, to avoid secondary sexual characteristics, induce an artificial puberty with hormones, and then transform the body through cosmetic surgery. All this to affirm the gender identity claimed by the child.
The title comes from a question posed by journalist
Jo Bartosch on Twitter. "Imagine if the word 'transexual' was still in common parlance-- how comfortable would you feel about a 'transexual 4 year old?" Considering that the protocol for trans children ends with gender affirming surgery or sexual reassignment surgery, it's an important question to ask. She asked it in relation to the appearance of the parents of a trans 4 year old on a UK morning tv program:
Are we calling the 4 year old in this story trans because that's an accurate description of someone who should eventually begin gender affirming therapy or because the parents call the child trans?
There is no standard definition of trans or gender. We used to refer to adults with pervasive gender dysphoria who medically TRANSitioned to present as the opposite sex, as they would with gender affirming therapy, as transexual. The people we might have unambiguously called transexual a decade ago became transgender people before becoming trans. It's no longer what people do, it's an identity, it's now who people are. It no longer necessarily even means the person has gender dysphoria. They simply need to identify as trans. So, what makes a child a trans child? They identify as trans or express the idea they feel like the opposite sex. How do they know? How does that 4 year old now accepted by parents as a boy know what it feels like to be a boy? More importantly, does that feeling warrant permanently changing the body to match the perceptions of the mind?
The treatment protocol of blockers, hormones, and surgery is often called experimental. There are no strong studies which validate gender affirming therapy as best practice. There are no studies which validate this use of Lupron as a puberty blocker. This use is based on its history of treating precocious puberty to delay its onset. There are many long term complications from this treatment especially resulting in bone disorders. The other licensed use of the drug is for patients with end stage prostate cancer and women with endometriosis. The recommendation is that it only be prescribed for a 6 month period to adult women. For adolescents at a critical developmental stage it may be prescribed for two or more years. Lupron is also used as a chemical castration drug for male sex offenders. One study recommended that the drug be reserved for the highest risk offenders because of the extensive side effects.
The social marketing for puberty blockers designed to allay fear or concern is that they are reversible. What does it mean to reverse delayed, cognitive, body, and bone development? Are they just saying that the developmental process of puberty eventually resumes? In the gender affirmation protocol the blockers are immediately followed by cross sex hormones. There are some health organizations that make clear this process may result in sterility. I'm not a doctor, but it's not clear to me how skipping the sexual maturation of puberty before inducing an artificial puberty for the opposite sex results in sexual maturation. It's very probable that the child is unlikely to ever experience orgasm. Can a pre-pubescent child with mental distress give informed consent to that?
Another consequence of this process is that the objectives of the first stage and final stage are in conflict. The point of puberty blockers is to stop the development of secondary sexual characteristics, like genitalia. For male to female patients the process of surgically constructing a vagina is most successful from the inversion of a fully developed penis and scrotum. For patients who have undergone pubertal suppression part of the intestine is needed to complete the procedure. Female to male patients face a high risk for post operative bleeding. Estrogen plays an important role in the structural integrity of vaginal tissue.
Based on the prestige of the many US medical associations advocating gender affirming care, one might assume that it's best practice. There are a number of reasons to question the assumption. One anecdotal reason has been playing out on tv since 2018. I Am Jazz follows the experience of Jazz Jennings who "came out" as trans at the age of 5. In 2018 she underwent gender affirming surgery. Due to ongoing complications she has had to return for surgery multiple times. On a date with a boy referred to as her boyfriend Jazz offhandedly remarks that she's worried she might not like sex because of "how effed up my vagina is." She struggles with depression and a binge eating disorder. This isn't to suggest that the depression and binge eating are because of the transition. People with gender dysphoria often have other psychological issues.
One study returned to a
FtM former patient 22 years after using this protocol to transition. The subject was in relative good health. He had none of the typical complications of taking puberty blockers. However, in that time he had had few serious relationships. His relationship of 5 years ended after he refused to cohabitate. He felt shame over the appearance of his genitalia. He seemed somewhat isolated and depressed, but doesn't regret the choice. In some ways this may be one of the best possible outcomes from this process of starting with puberty blockers. But is this the best outcome "trans children" can expect?
This brings us to where we began: What defines a trans child separately from a child? What happens if a trans child doesn't know they are trans? What happens if their gender identity isn't affirmed? The social messaging of the moment is that without gender affirming care children will commit suicide. There is no evidence that gender affirming therapy improves mental health and functioning. There is evidence that the vast majority of children with adolescent gender dysphoria will desist or grow out of it with puberty. Most grow up to become lesbians or gay men. Begs the question, why address temporary mental distress through irreversible cosmetic changes to the body?
Across the west there has been a 4000-7000% increase in children identifying as trans in the last decade.
According to research, the vast majority will desist with puberty. How does the gender affirmation process determine which children will desist and the fraction most likely to persist? It doesn't. Asking a patient about her feelings to determine the nature of her dysphoria isn't the same as attempting to "repair" gender identity, whatever that means, but desistance may be an outcome. Is it conversion therapy to help kids feel comfortable in their body without needing to make permanent changes while medicalized for life? If it is, "conversion therapy" is the protocol in Finland, the UK, and Sweden's largest hospital. For various reasons their protocols now begin with increased psychological support, reserving medical transition as the last resort.
"Trans children" is a self fulfilling prophecy designed to cultivate gender confusion in kids and convince them the natural awkwardness of beginning puberty means they are trans. This places them in a protocol that begins the process of preparing their bodies for irreversible changes through the experimental use of a chemical castration drug on the basis of their own diagnosis. They are not evaluated for gender dysphoria. There is no process for determining if transition is the best option, just an evaluation of mental health. The protocol begins by stopping the precise developmental process. which makes the protocol irrelevant. Most children with gender dysphoria will desist with puberty. The number drops dramatically with children who socially transition before puberty. 98% of children who start puberty blockers go onto hormones.
I've read numerous people equate the trans movement with child sexual grooming. It used to feel like over the top hyperbole. I completely understand now. Even if you can't, consider the ways in which children may be victimized by this process. In no other area of medicine are children or adults given elective experimental treatments with low evidence. There may be children with gender dysphoria, but "trans children" is an invention. It wasn't created to benefit any children. The presence of close friends going through social transition and a proliferation of youtube personalities as well as broad institutional capture of trans ideology precipitates more children identifying as trans. We don't know exactly how many regret transitioning and decide to de-transition after making permanent bodily changes. The ease of gender affirming therapy assures that a growing number of "trans children" who would have grown comfortable in their unaltered skin will be among those expressing regret. Those children deserve better protection before it reaches that juncture.
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