President Donald Trump’s executive order cutting federal support for the gender transition of minors reflects the impact of health care professionals, whistleblowers and detransitioners who are questioning whether gender clinics’ well-intentioned medical interventions may be harming children.
The body of work supporting this position is significant and growing.
One scholarly critique challenges the myth of “reliable research” in pediatric gender medicine, contending that medically modifying the bodies of gender dysphoric children entered clinical practice worldwide without “the necessary rigorous clinical research” to confirm that “robust and lasting psychological benefits” outweigh the burdens of “lifelong dependence on medical interventions, infertility and sterility, and various physical health risks.”
James M. Cantor’s fact-check of the American Academy of Pediatrics’ policy on gender care concludes that the academy advocates “for something far in excess of mainstream practice and medical consensus” and that its statement “is a systematic exclusion and misrepresentation of entire literatures.”
Despite that thin evidence base, as Jennifer Block reports, “More adolescents with no history of gender dysphoria — predominantly birth registered females —are presenting at gender clinics.” Some “121,882 children ages 6 to 17 were diagnosed with gender dysphoria from 2017 through 2021,” with at least 18,000 of them beginning treatment with puberty blockers or hormones.
Block notes that up to 2% of high schoolers say they identify as trans, and they are more likely than their peers to have conditions such as depression, anxiety, attention deficit disorders and autism.
And researcher Marc J. Defant concludes that “Ethically, the potential for irreversible harm combined with high rates of desistance and co-occurring mental health conditions, necessitates a more cautious approach to early interventions.”
While the question before the Supreme Court in the United States v. Skrmetti was whether Tennessee’s ban on medical body modification for minors with gender dysphoria is sex discrimination, the justices seemed troubled by the conflict between therapists and doctors who consider medical body modification for minors to be ethical and clinically indicated, and psychological and medical professionals disputing such claims.
The liberal justices seemed more willing than their conservative colleagues to minimize the risks of gender medical treatments and to create a new class of transgender persons.
That reluctance is reasonable. As the editors of The Journal of Child Psychology and Psychiatry have stated, “distorted body image is common . . . in all age groups,” and “there has been a steady increase in the number of people undergoing medical body modification to alter their physically healthy bodies in invasive and nearly irreversible ways.”
Both gender dysphoria and body dysmorphic disorder involve a perceived “mismatch” between the physical body and how the individual views their body.
Yet, according to a 2016 review, for the majority of those with gender dysphoria diagnosed in childhood, feelings of gender discomfort “remit around or after puberty without the need for any intervention”.
Traditionally medical body modification has not been used for body dysmorphic disorder since it doesn’t address the root cause of the disorder. Instead, psychiatric treatments, including psychotropic drugs and cognitive behavioral therapy, have been used. However, psychotherapy for gender dysphoria has been hindered by concerns about coercive conversion efforts when the therapy is perceived as not “affirming” enough.
Diane Ehrensaft outlines the historical shift from the “live in your own skin” care model, which helps the child accept a gender identity matching birth sex, to the watchful waiting model, which delays social transition until adolescence. The recent shift from those models to the medicalized so-called “affirming” model is based on the assumption that when “it comes to knowing a child’s gender, it is not for us to tell, but for the children to say.” To this way of thinking, there’s no need to wait until adolescence to affirm the child’s decision. Otherwise, a youth living in an inauthentic gender may be prone to psychological harm.
But Moti Gorin argues that autonomy-based views are misguided, because they contradict the medical profession’s long-standing commitment to the principle of doing no harm to patients. Adolescents have difficulty regulating their behavior and emotions and are prone to impulsivity and risk seeking. Their decision making abilities are simply not on par with adults.
Certainly, treatments for other body dysphoric conditions do not follow the autonomy-based model. For example, surgeons don’t generally amputate the healthy limbs of people with body integrity identity disorder, nor perform, as Erika Bachiochi has pointed out, anorexia-affirming bariatric surgery.
Yet, Michael Lovelock argues that “body culture media” image of the transgender person trapped in the “wrong body,” popularizes physically altering the body to resemble one’s “true” intuited gender. Monique Robles maintains that such affirmation of one’s “inner feelings” of gender is naïve and promotes “a dualistic nature wherein the body has no value.”
Because none of us enters this world without a body, Ryan T. Anderson and Robert P. George contend that “Our bodies are essential aspects of ourselves as the kind of entity we are — a certain type of animal with a rational nature, a human being. We … are personal bodily organisms. And the sex of an organism is determined by how that organism is organized with respect to sexual reproduction. As there are two complementary ways of being sexually organized, so there are two sexes: male and female.”
Anderson and George maintain that “Children who feel deep discomfort with their bodily sex should be treated with kindness, respect, compassion, and love. They need to be protected from bullying, teasing, discrimination, and any form of mistreatment. . . . This includes providing counseling for any underlying trauma or for social dynamics at home or school that may play a role in the dysphoria. And it includes helping them to break down misguided sex stereotypes or cultural expectations that may underlie their dysphoria.”
Maybe God, Tennessee and Mr. Rogers got it right: the sexually dimorphic human body is a good in itself, an irreplaceable gift. Surely we ought to be able to teach that to our children.
The General Assembly of Tennessee found that the state “has a legitimate, substantial, and compelling interest in encouraging minors to appreciate their sex, particularly as they undergo puberty,” and to discourage medical treatments that “might encourage minors to become disdainful of their sex.”
If, as Walt Whitman asserted, “a mouse is miracle enough to stagger sextillions of infidels,” the human body is miracle enough to stagger all the rest of us. We should be wary of warring against our own bodies psychologically or medically. That’s why Tennessee, Utah and 23 other states are right to try to prevent what some refer to as “medically assisted self-harm” to minors, and are instead encouraging appreciation for the human body, and noninvasive psychological care to address minors’ gender/body dysphoria.
Camille S. Williams is an attorney practicing in Provo who writes on women’s and family issues. The views expressed are her own.