Do Not Allow Them to Medically Transition
Childhood is a time of play and discovery. It is a time to try things on, and try things out. Humans have the longest childhoods of any species that has ever evolved on this planet— a powerful indicator that we have much to learn as children in order to become highly capable adults. Children explore and experiment with belief and identity. Childhood should not be a time in which any given experiment seals your fate.
In our lineage, we have had two sexes, with endocrinological systems that regulate our form, function, and development, for hundreds of millions of years. It is a system that is both ancient and complex. But hormones are now being pushed by doctors and drug companies—and assented to by parents—as if we have no history with them at all. These hormones include puberty blockers, notably GnRH (Gonadotropin Releasing Hormone), which are often begun in the early teen years. This may then be followed, in the mid-teen years, by cross-sex hormones, specifically estrogen and testosterone. Our history with these hormones is long, and their effects on us complex and cascading, interwoven with myriad systems. Yet we are experimenting on our children as if puberty is a matter of choice. Having mustard or mayo on your sandwich is a choice. Wearing pants or a skirt is a choice. Playing soccer or basketball with friends is a choice. Puberty is not a choice.
Puberty is critical, and messing with ancient hormonal systems has serious downstream effects that will never go away. Much of the research on the effects of hyper-novel medical intervention is written by people who are already invested in disrupting children’s development, but even so, we find that bone mass is negatively affected, as are several physiological parameters, including blood volume, cholesterol and several other hormones. Furthermore, giving GnRH at onset of puberty affects cognitive function in an animal model (sheep), impairing spatial memory.
It is also true that many young people who medically transition later detransition, or desist, citing reasons as varied as becoming more comfortable identifying as their natal sex; coming to understand themselves as lesbian, gay or bisexual; and having concerns about potential medical complications from transitioning (see especially Littman 2021 and references therein, and also the Pique Resilience Project). Many desistors also report that they “did not receive an adequate evaluation from a doctor or mental health professional before starting transition.” For those young people who identify as trans, and later desist, given the irreversible effects of puberty blockers and cross-sex hormones, certain doors will have permanently shut for them: they can never become what they might have been.
Some state legislatures are trying to stop the experimental drugging of children, but they are swiftly called “transphobic” and “anti-science” for doing so, by the media and by politicians eager to score points. Even professional organizations have fallen prey to this blindness. Consider, for instance, the recent statement from the Society for Research in Child Development, in which they argue for medical interventions for transgender children, without ever mentioning the effects that such interventions will have on the non-transgender children who would thus be altered forever. They would seem to be thinking only of the vocal minority, never considering the less visible children who stand to be permanently damaged by such policies.
The “affirmative care” model proclaims that if a child says they are trans, then they are trans, and any discussion or pushback is considered damaging to the child. This model is increasingly the norm, even mandated in many health care settings. The affirmative care model not only woefully misunderstands childhood, but also puts a much larger fraction of children at risk. Allow me to explain.
We are told that people who turn out to be trans as adults—a tiny but real fraction of humanity—tend to know this of themselves when they are young, and to say so. This is no doubt true.
But what of the vast numbers of children who say similar things when they are young, but do not turn out to be trans? There will be no data on this, but all parents know that children say things that are impossible. They are exploring, they are fantasizing, sometimes they are testing the adult waters to see what works, what gets a rise out of the parents, what gets them attention. This is to say nothing of the abused children who are even more likely to retreat to fantasy in order to create a stable identity, and who will be further harmed by the affirmative care model.
A child may declare herself a unicorn one day, and a turtle the next. Unlike hormones, preferences from foods to colors to friends are transient, and can easily be exchanged as the child tries out new ways of being. It’s as if, as a society, we have forgotten the distinction between simile and metaphor, or perhaps we are pretending that children knew the difference all along, and are ever precise in their language. But until yesterday, we all knew that “I feel like a boy” is not the same as “I am a boy.”
Given what childhood is, and how many fantastical and untrue things come out of children’s mouths, “everything children say is literally true” is an absurd and dangerous premise on which to base medical care.
Furthermore, we are told that failing to intervene, hormonally and medically, for those children who declare themselves trans, puts them at risk of failing to become their true selves. This, we are told, would be a grievous error.
But what of the other possible error?
Intervening at an early age with experimental and disruptive medical practices for all the children who declare themselves trans, risks harm to a large number of non-trans people for life.
Compare the two risks side by side:
fail to intervene at an early age, such that a tiny number of actual trans people begin physical transition later and come to be a less good fit for their internally perceived sex; or
permanently disrupt normal development for children who were merely exploring their identity.
Which error does society prefer to make?
In the language of statistics, we can frame the decision this way: The null hypothesis is that you are not trans. This presumption is based on the fact that a persistent, deeply felt disconnect between your actual sex and your perceived sex is extraordinarily rare in humans. It must be, evolutionarily. No mammals are known to have ever switched sex. Nor any birds, for that matter—birds which also, like us, have sex chromosomes that determine what sex they are. So in those of us who belong to clades whose individuals have never switched sex, a deep-seated sense that you are not the sex that you actually are will be exceedingly rare.
The alternative hypothesis—that you are trans—can only replace the null hypothesis—that you are not—with compelling evidence. And the assertions of a child are simply not sufficient.
Do we, as a society, prefer to bias towards false positives (type-I errors), in which we mistakenly assume that some people are trans even though they are not; or do we prefer to bias towards false negatives (type-II errors), in which we mistakenly take some people for not-trans, even when they are?
To prefer the first is to broadly encourage transition. This means transition even for those who do not turn out to warrant or want it, with all the attendant downstream effects: physical, mental and sexual disfunction across a range of systems, many of which we cannot yet even know. Again, this is the “affirmative care” model.
To prefer the second (false negatives), on the other hand, is to recognize that if we do not intervene early, some trans-adults will be a somewhat less good fit for their internally perceived sex than they might have been. Delay treatment until adulthood, and the adult will bear more of the marks of the sex-specific puberty that is a match for their natal sex.
Type-I errors create false positives, in which people who are not trans are treated as if they are.
Type-II errors create false negatives, in which people who are trans are treated as if they are not.
Given that the background rate of trans people is exceedingly low, it is our human and societal responsibility to minimize type-I errors in this case—to drive as close to zero the number of healthy children harmed by medical intervention. This is for two reasons. First, the sheer numbers of people who will be harmed by making type-I rather than type-II errors is far higher. Second, intervention in a functional, ancient system when no demonstration of the safety of those interventions has been made, and indeed when we already know some of the harms of intervention, goes against all that is right, moral, and just.
The treatments for people who are trans—puberty blockers, cross-sex hormones, and surgery—have permanent costs, make no mistake. For the vast majority of children and youth who are merely exploring identity and belief, doing what children do—those costs are unacceptable. We must protect childhood, and we must protect children1.
Finally, I would enjoin the reader to consider the possibility of financial incentives in the rise of puberty blockers and cross-sex hormones. We are told that trans people will suffer harm if access is delayed until maturity. In some cases, this may be true. But who profits from the ever-wider acceptance and prescription of these drugs? The companies who make the drugs are those who profit. If you were such a company, and you had a product that nobody knew they wanted or needed, or even knew existed, how might you go about generating demand for your product? Convince would-be consumers that they were incomplete and miserable without it. Further, convince those would-be consumers of your products that those who would keep them from the drugs are trying to kill them.
Among adolescents, attempted suicide is higher in those who identify as trans than those who do not. The high rate of suicidal ideation and behaviors among trans people has been contorted by activists, some of whom argue that keeping people from transitioning is risking—nay, inviting—their suicides. This is propaganda. If any of the players are getting people killed here, it’s the companies, organizations, and yes, activists who are pushing drugs on children. These children and young adults are being sold a story that allows them to feel seen and embraced for a brief moment, before being abandoned to the downstream effects of having disrupted an ancient system with no plan, and no escape.
One such company advertises that their puberty-blocking-drug provides “Childhood, Uninterrupted.” It’s a Peter Pan fantasy with none of the upside. Children can imagine a carefree life of fairies and no responsibilities, and perhaps parents believe that they will have their little ones with them forever, unchanged.
The children have an excuse: they’re children. We can make no such case for the adults. We will look back on this era in horror, a time when we played God with complex systems that evolved over hundreds of millions of years. We have all the arrogance of Zeus, and none of the wisdom.
It is difficult to know exactly what the numbers are for various things: How many people have historically identified as trans? How about in the current moment? Does it vary by demographic markers, and if so, which ones? This excellent site, StatsForGender.org, does a fine job of compiling much relevant research.