As anyone who has spent time reading my blog well knows, I am highly skeptical of the scant existing research which purports to show a binary, static “male” or “female” brain. To my knowledge, there is no research in existence that proves a gendered brain is present from birth; and that that gendered brain is unchanging and persistent throughout the lifespan, regardless of lived experience. ** (see note, bottom of post)
But for the purposes of this post, and despite this dearth of evidence for “brain sex,” let’s just assume that the strident proponents of childhood transition are correct: there is an immutable male and female brain, set in stone and impervious to change via life experience. (Of course, this flies in the face of the settled science of neuroplasticity—but we’ll ignore that for the time being). Further, we will assume that, for a small percentage of people who experience gender dysphoria in childhood (no more than about 20%, the number generally agreed upon even by the most zealous transgender advocates), this gendered brain is mistakenly lodged in the skull of the “wrong” body. It follows that there is such a thing as a truly transgender child. These kids really do have a mismatch between brain and body, and the most humane and medically responsible thing that can be done for them is to let them “transition” to the opposite sex, post haste. As young as possible.
Case closed? Not quite.
First, let’s be very clear what we are talking about here, in terms of pediatric medical treatment. The current protocol for children identified as transgender is puberty blockers (GnRH agonists) administered at the onset of puberty (Tanner Stage 2). The child is then monitored for several years, and if they continue to believe they are the opposite sex, cross-sex hormones are started, so as to prevent natural puberty occurring in the “wrong” gender (i.e., the biological sex of the child). In the case of a natal girl with two x chromosomes and a biologically female body, she will not go through maturation of the ovaries, menstruation, breast development, nor other primary and secondary sexual characteristics. Cross-sex hormones (testosterone for a girl) will cause her to develop more in line with the sexual characteristics of a male: a slightly enlarged clitoris, increased body and facial hair, and an enlarged larynx resulting in a deepened voice. She will thus avoid the assumed trauma of going through the “wrong” puberty, with shrinkage and no maturation of her internal reproductive organs. She will appear more or less as the gender (male) she (now he) identifies with. These changes are permanent. They cannot be undone.
And one of these permanent changes is of special import: In nearly every case, this treatment protocol will result in irreversible sterility. This child will never be able to produce their own biological children. However, the gender experts believe this outcome is worth it and justified for “truly transgender” children. The puberty-blocked girl (who still has the brain of a prepubescent child, not that of a maturing adolescent) agrees that transitioning is far more important than future fertility, and the adults in charge make the monumental decision to destroy the child’s future reproductive capacity.
Fair enough? Maybe, if we continue to assume that there is such a thing as a “truly transgender” person with an immutable, innate gender identity; if we treat this condition as a sort of birth defect that will never change, even later in life; and that the young person in question will be forever miserable to the point of suicide if they do not chemically and surgically alter and thereby sterilize their hated and mistaken body.
The problem is, these gender experts—from the most certain to the most cautious—agree that they don’t reliably know which of these children really will be transgender for life. And what that means is there are going to be some false positives: kids who will mistakenly go through extreme medical and pharmaceutical treatments—not just in childhood and adolescence, but for life, since hormones must constantly be administered to suppress the “wrong” body from reverting to the characteristics normal for the genetic makeup of the person. Some number of these kids will have been misdiagnosed. It’s inevitable. Even the most careful clinician, who believes they have narrowed their treatment cohort to only those children who are most “persistent, consistent, and insistent” cannot prevent this, because the research simply isn’t there to tell clinicians who will or won’t grow up to be truly transgendered.
Let’s agree, for the sake of discussion, that these gender clinicians—and the parents who are authorizing the treatments—truly believe they are doing the right thing. They believe that these puberty-blocked children who continue to insist they are the opposite sex are correct. It’s worth repeating that these children’s brains, and thus their critical thinking, reasoning, judgment, and other aspects of executive function, have also not been allowed to mature; because puberty is about brain development, not just secondary sex characteristics. No matter how careful these clinicians and parents are, they are still going to catch a few wrong fish in the transition net they are casting.
Does this matter? How many misdiagnosed kids are acceptable? How many sterilized children (many of whom might otherwise have grown up to be gay or lesbian adults with a desire for their own biological children) are ok? 100? 50? 20? 2? 1?
Put it this way: If there were any other treatment, for any other disorder, which resulted in sterilizing prepubescent children, and which caused irreversible, permanent changes with as-yet-unknown side effects, you’d better believe that treatment would be limited to only the most extreme cases—and even then, only after extensive clinical trials. These clinical trials would span years of rigorous peer review, with successful completion of many replicated and corroborating studies, involving thousands of subjects. These human trials would have to look at physical and psychological side effects and risks of this extreme and lifelong treatment.
Rigorous study, with several phases of clinical trials, is the norm for modern evidence-based medicine, even for life-threatening medical conditions. To take but one contemporary example, there has recently been a successful drug treatment protocol released for the treatment of chronic hepatitis C, which with prior treatments, had a rather dismal cure rate. Despite the promise of the ongoing clinical trials for the new hepatitis C drugs (over 90% cure rate), which took place over many years, the general public was not allowed access to these life-saving drugs. Many people died waiting for the drugs to be approved. If the side effects of these drugs had included sterility—for adult patients—it is highly unlikely the treatments would have been approved by the FDA. Even though the drugs might have saved many lives.
We don’t remove organs and body parts, we don’t give children powerful drugs for any other disorder based on what currently amounts to clinical guesswork. We don’t remove organs or administer chemotherapy because someone might go on to develop cancer later. We don’t prescribe poorly studied, off-label drugs or perform surgery on children to relieve them from psychological distress in any other case apart from “gender dysphoria.” Surgeries and lifelong drug treatment are rightly seen as last resorts, not the first line of treatment for a problem that might turn out to be transient.
The media and trans activists are constantly telling us how important it is to transition children—as young as possible. But what about the kids who might be wrongly diagnosed? Why does no one talk about them? Why is their future happiness not a subject for media exploration? What about the suicide rates of adults who realize with horror later in life that they actually don’t want hormones and surgeries? That it was all a big mistake? That they don’t want to have to routinely stretch or pump up their artificially constructed sexual organs to keep them in some sort of working order? What about the adults who will mourn the children they were never allowed to bear because of decisions made by parents and doctors decades earlier?
If we care about all children, including the 80-95% of kids who in fact are only “gender nonconforming”; if only a small number of “truly transgender” children exist, why not allow those few to transition as adults, when they have the cognitive wherewithal to decide for themselves? Why not simply help them cope with their feelings of dysphoria in childhood, instead of stunting their intellectual, emotional, and physical development, and risking the huge mistake of proactively sterilizing even one non-transgender child for life?
Would it really be so terrible for parents to simply let their kids wear what they want, pursue activities they want, heck, “identify” as they want, without the medical piece?
It only takes one person to file a malpractice lawsuit. There is no minimum number for a class action suit, but given the increasing numbers of children undergoing these early transition protocols, the typical 20-50 plaintiffs is not an unlikely number for future adults willing to litigate; a fraction of the people who will wish their parents and doctors had simply allowed them to dress and behave as they wished as children, without making permanent decisions that could not be undone.
So I ask the gender specialists, the parents, the activists, the journalists celebrating the medical transition of children: Granting you for the moment that your fervent belief in immutable, innate gender corresponds to reality, what concern do you have for the children who will be wrongly sterilized, drugged, and surgically altered? Do those children matter to you at all?
Is it acceptable to wrongly sterilize even ONE child?
** Such studies would be difficult to conduct. To come close to proving significant differences between male and female brains that result in innate transgenderism, researchers would necessarily have to scan large numbers of identical twins at birth. These twins would then have to be separated and raised in different environments, then be followed into adulthood. (Genetically identical twins are necessary to prove innate brain physiology, and the twins must be raised separately to control for the effects of life experience and influence, which would need to differ to prove that nature trumps nurture). A statistically significant number of those pairs of twins would then have to both be transgender-identified to prove that transgenderism is an essential and innate trait of the human brain.