When COVID-19 began to crash over the United States, leaders responded by placing their states and communities on pause, suspending everything possible, including non-essential surgeries and medical care. During this time, my friend's mastectomy for aggressive breast cancer was deemed essential, but the liposuction she wanted to have done to source her reconstruction was considered cosmetic. The extraordinary circumstances of the pandemic required making a distinction. Though inconvenient, it was clear: one surgery could wait.
I think of my friend's situation whenever, amid news of the pandemic and its effects, disruptions in transgender medicine are highlighted. One article featured a twenty-three-year-old who identifies as a man, who worries about having to postpone the mastectomy that "will make me feel better and feel like I'm in the right body for once." The title boldly declared that such surgeries are life-saving and that delays can be "dangerous and even life-threatening," citing a study that has been critiqued in detail here at Public Discourse . Another recent article discussed supply disruptions that affect transgender individuals' access to hormones and other medications on which they are now dependent.
A pandemic exposes many truths. Performing radical surgeries on healthy bodies, with the hope of improving body dysphoria, are in fact elective and are neither essential nor life-saving. "Stress" and "disappointment" are not malignancies, and " chest dysphoria " does not metastasize. The increased incidence of mental health conditions and the elevated risk of suicide remain for transgender-identified individuals at every stage of transition ; and research consistently shows that medical interventions and body modifications, no matter how deeply desired, do not widely deliver measurable results in terms of objective health and well-being .
With respect to hormone use, is lifelong medical dependence really the optimal outcome for anyone? The study touted for the "life-saving surgeries" found no effect of "time since initiating hormone treatment" on the likelihood of subsequently receiving mental health services. If there are other means of treatment that leave the healthy body intact, wouldn't that be considered the better standard of care? These considerations are pertinent to the well-being of gender-dysphoric adults, of course, but they become even more important with respect to children.
Before COVID-19's pernicious spread, another health phenomenon had reached epidemic proportions and is still occurring on a global level: gender dysphoria. Unlike the virus, its vulnerable population is the young, especially adolescent females . Charts of exponential increases in referrals to gender clinics abound, showing increases of over 4,000 percent in the United Kingdom and 1,500 percent in Sweden over a ten-year period. The same pattern is playing out across many nations , with no sign of slowing down.
In medicine, culture, and law, the protection of vulnerable minors has long been an accepted norm. In 2012, for example, the Supreme Court ruled that an automatic life sentence in prison without parole was "cruel and unusual punishment" when dealing with a minor. Kagan's words in the majority Justice opinion provide a powerful parallel when considering transgender youth: "Mandatory life without parole for a juvenile precludes consideration of his chronological age and its hallmark features - among them, immaturity, impetuosity, and failure to appreciate risks and consequences." Research on frontal lobe maturation confirms common knowledge: children and teens need more guidance and protection than adults. Whenever children are treated as adults or given premature responsibility or authority, they experience a loss of proper protection and are left vulnerable - both to others and to the consequences of their own decisions and actions.
Unfortunately, trans-identifying youth are not given the same consideration that other minors are given, nor are they treated with the same standard. They are treated not only as adults, but as exceptionally prescient and self-sacrificial ones. As a result, today many of them are being given automatic life sentences.
Consider how gender-affirming experts address concerns about infertility and sterilization. Citing the inflated risk of suicide among the gender-dysphoric, transition treatments are compared to cancer treatments - they are said to be as " life-saving " for gender-dysphoric youth as oncology treatments are for those afflicted with cancer. While both may compromise fertility, they reason, both are equally justified because of extreme medical need.
In making these medical decisions, gender-dysphoric youth are credited with extraordinary selflessness and forward thinking. In the words of clinician Diane Ehrensaft :
And what I will say about many of the youth who want puberty blockers is: I have never met such an altruistic group of kids around adoption! Never! "I will adopt because there are so many children who need good homes." And I think that's both heartfelt but also, they're trying to tell us the most important thing to me right now is being able to have every opportunity to have my gender affirmation be as complete as possible. Anything else is secondary.
Adoption is a beautiful thing; but given the drastic (and unethical ) lengths to which individuals will go to have a genetically related child, rather than adopt, it is wishful thinking to assume that the same desire won't emerge later in the adult heart of the now twelve-year-old child who is being placed on puberty blockers, especially of a child who is admittedly prioritizing what he or she wants "right now."
Trans-identifying youth are also assumed to have extraordinary maturity concerning medical decisions and even participation in research. In a qualitative study that explored the attitudes of trans youth on the subject of puberty suppression , the authors state:
The adolescents also showed that they seriously weighed the short- and long-term consequences, and consciously chose for the treatment. Furthermore, they showed a remarkable insight and altruism in their willingness to participate in research, which also meant they were able to look beyond their own short-term interests.
Additionally stunning was the fact that, "compared to clinicians, adolescents were often more cautious in their treatment views." When minor children are more cautious about their treatment than their doctors in experimental medicine, and are serving as their own gatekeepers, something has gone dreadfully wrong.
Gender clinics are normalizing infertility-inducing and permanently disfiguring surgeries, in children, on the advice of medical research conducted without control groups, without concern for effect sizes, and without sensible understandings of risks versus benefits. The American Academy of Pediatrics, and other professional organizations, have been quick to throw their weight behind actions that should not pass a Human Subjects Review committee, due to the lopsided risk, the modest benefits, and the violations of the principle of (truly) informed consent for minors . The Standards of Care espoused by the same organizations, claim consensus on early medical interventions where there is none ; they contradict the scientific literature ; and they emerge from contexts riddled with conflicts of interest and profit motives . This is not how medical research and clinical operations are supposed to work.
In the race against the coronavirus, thousands of people have expressed interest in a " challenge study ," in which they will be intentionally infected with COVID-19 in order to speed the development of a vaccine. Will the challenge studies be open to minor children to participate? What if the kids are deemed precocious, exceptionally altruistic, and able to weigh the risks, and what if they want to proceed for the common good? Will we begin vaccine trials with willing children volunteers? No, because our responsibility as adults is to protect them from things to which they cannot fully consent, and we don't willingly put them at risk - unless it involves transgender "medicine."
Mikael Landén, a Swedish professor of psychiatry, has questioned both the rapid increase in gender dysphoria among young people and the current affirmation approaches, citing the lack of evidence of which treatments actually help, and especially considering that many of the treatments are irreversible . Landén aptly says: "The medical system needs to take a step back and ask if this larger group of patients are helped by the same treatment as was previously reserved for a very small and carefully chosen group. . . . [I]t must be studied ." Organizations like the Society for Evidence-based Gender Medicine are forming to advocate for and answer that call.
In addition to better research, legislative efforts are necessary to protect youths when standard medical and professional safeguards are failing. Earlier this year, South Dakota sought to establish such protections. Notably, many transgender adults supported the bill, arguing that no child can consent to the lifelong medical dependence which they live and know firsthand . The opposition framed proponents of the bill as having malicious intent towards the transgender community and claimed that "children . . . are going to die because of this ." But as we know, kids won't actually die from a lack of Lupron (in fact, the reverse is more likely).
Despite having impassioned and knowledgeable medically-transitioned adults like Scott Newgent as advocates, the effort failed in South Dakota. Let's hope Ohio and other states start to listen to people like Scott, Walt Heyer , and Hacsi Horvath and find the courage of Sweden and the UK, both of which recently decided to restrict irreversible transition treatments to the age of majority. These bills aren't anti-trans; they're pro-youth.
In COVID-19's hardest hit state, "PAUSE" became an acronym that reminds us of the ultimate goal: " Policies Assure Uniform Safety for Everyone ." It's time to assure the same safety for trans-identifying youths that we do for all youths. No more automatic life sentences. With respect to the global transgender epidemic, pressing pause is long overdue.