Time to rethink gender transition for kids

Within the past few weeks, two major medical groups, the American Society of Plastic Surgeons and the American Medical Association, have issued statements recommending against gender-affirming surgeries on minors. This is a break from the past few years, when all the relevant medical societies endorsed these treatments. It comes on the heels of the first verdict in favor of a detransitioned woman who underwent a double mastectomy at age 16. As with nearly everything in modern life, this issue has been tainted by politics. The Trump administration, with its characteristic brutishness, has targeted trans people — firing trans service members from the military, forbidding Veterans Affairs hospitals from providing trans care, and more. The right's contempt for people in genuine distress is almost enough to make one embrace the full gender-affirming model. But not quite, because this is about what's best for kids. As the statement by the American Society of Plastic Surgeons noted, it isn't just surgeries on those younger than 19 that they now discourage, but a whole panoply of gender-affirming care because there is good evidence that a "substantial portion of children with prepubertal onset gender dysphoria experience resolution or significant reduction of distress by the time they reach adulthood, absent medical or surgical intervention." It's odd that so much ink has been spilled about the question of sports and the unfairness of natal boys potentially snagging prizes over deserving girls. That's unjust, but really, it's insignificant. The number of trans athletes is very small, and the harm, while real, hardly begins to match the damage that may be done to kids who are rushed into transitioning without proper evaluation. As BBC journalist Hannah Barnes found in her examination of Britain's transgender program, 60% to 70% of the kids who presented at the clinic with gender distress would eventually grow up to be gay. Most parents desperately love their kids and don't want them to suffer, so it's inexcusable that some clinicians were telling parents that unless they agreed to support their child's sexual transition, the child would be likely to commit suicide. The doctors sometimes said, "You can have a live girl or a dead boy" or vice versa. Chase Strangio, the ACLU lawyer who argued the U.S. v. Skrmetti transgender case before the Supreme Court, reluctantly acknowledged during oral argument that there is no evidence that gender-affirming care reduces suicide. Parents have been disserved by a medical establishment that got carried away by a cultural fad and failed to protect children. Puberty blockers were advertised as a fully reversible intervention that would simply give children "time to think" before their bodies began the process of maturation. But in fact, between 96% and 98% of patients who started puberty blockers went on to cross-sex hormones (whose effects, like body hair, deepening of the voice, and development of an Adam's apple, are not reversible). Rather than a pause, it was a first step on the ladder. As the Cass Review in the U.K. stressed, the studies on these interventions are of poor quality and lack long-term data on how adults who transitioned as children are faring. If a child proceeds from blockers to transition, one thing many natal males will lose is the capacity to achieve orgasm. Is a child able to understand the nature of that trade-off? Most boys and girls will also lose their fertility. How many kids are being diagnosed as trans and put on the pathway to transition and lifelong medication, infertility and sexual anhedonia, when their real issue was discomfort with being gay, autism, a history of sexual abuse, depression or mere confusion after absorbing online content? The vast majority of children with gender dysphoria have other medical and psychological issues as well. Are they being carefully evaluated? Not always. Dr. Johanna Olson-Kennedy, a leading practitioner of transgender medicine, rejected the idea of extensive psychological evaluation in 2018, explaining that "I don't send someone to a therapist when I'm going to start them on insulin." Throughout history, there have always been a small number of people (mostly male) who feel that they are in the wrong body. But as a number of surveys have found recently, the share of young adults who are trans or nonbinary is dropping. The Cooperative Election Study, which included 60,000 respondents, found that in 2020, 8.6% of 18- to 24-year-olds identified as transgender. By 2024, that share had declined to 3.2%. Most of the people who embrace gender identity do so to be inclusive and humane. The movement for trans rights seems like the struggle of gays to achieve true equality. In one sense, it is. Discrimination against trans adults needed to be stopped, and transgender people of all ages deserve respect. But as Europe, our own medical establishment and juries are coming to see, the trend to aggressively alter children's bodies and minds was too much too soon. That Americans are tapping the brakes now is a welcome corrective.