I don't have anything interesting to add, but just want to say that this was really thoughtfully written--one of your best pieces yet. I really appreciate that while you're skeptical of how progressives are approaching this issue, you take pains to affirm the importance of shared dignity and compassion as a starting point for these conversations.
I'm often in the uncomfortable position of being a little exasperated with the dogmatism of my fellow progressives, but then also feeling completely repulsed when I try to find alternative voices to help me figure out what I really think, only to find that they are ALL essentially the "just asking questions" guy. Like, are my only options really progressive Twitter or the so-called Intellectual Dark Web (ew)? Slow Boring provides what I think of as respectful skepticism, and even when I disagree with you, I always find it helpful to read.
I am an Ob-Gyn resident. I actually somewhat regularly am involved in providing gender affirming care to adults. And it’s something I do happily without reservation, as the patients have been appropriately counseled and transitioned for several years (many times >5 years) prior to under going surgery that removes their reproductive capacity.
I have significant reservations about any medical transition in teens, especially when combined with puberty blockers. I do not think they can provide consent. This is not a small issue.
Puberty blockers prevent sexual maturity, this is more than just physical changes, it is a critical period of mental and psychological development. Additionally, puberty blockers followed by opposite sex hormones does not allow for reproductive maturity, severely and even eliminating fertility options. It can also make gender affirming surgery very difficult down the road and even limit pleasure from intimacy.
I do not believe any adolescent had the ability to adequately consent to these life changing decisions. I also do not believe they have had enough time to adequate distinguish between sexuality and gender, before they have even reached puberty.
Moreover, in medicine, we have historically been so momentously wrong and ethically challenged when limiting or inhibiting fertility in patients with questionable ability to consent.
I worry that the field (peds endocrinology) has not had to reconcile the ethics of impinging on fertility and I worry for these patients 15 years from now. I have no doubt there will be many class action lawsuits and the patients should win.
And the evidence that medical transition is needed to avoid severe mental health outcomes is very weak. Medical transition vs non-medical gender affirming care in teenagers has never been tested adequately.
If a child has mental health problems, the idea that physically transitioning will cure them seems asinine. What are the mental health problems? "Mental health" is nebulous and in many cases is something that AT BEST can barely be managed with incredible amounts of social and medical support. Using mental health as a righteous excuse to carpet bomb society with physically and chemically transitioned children sounds like a great way to ensure work for unscrupulous doctors and drug companies. And this after hundreds of thousands died - and millions were affected - under the lie of compassionate pain management.
In fact, gender affirming top-surgery for teens, particularly those assigned female at birth (AFAB), had once been fairly rare, but by 2020 it had become increasingly common. A report published by The National Institutes of Mental Health (NIMH) would report that,4,830 teens had breast implants in 2021, while an additional 4,700 had breast reductions. That’s was almost 10,000 yearly and it was growing each year. It had even become common among some teens to ask for breast surgery as a “graduation present” upon completing high school.
Such procedures are not limited to bodies. Other teens are having surgeries to their faces to make them look more stereotypically feminine—30,000 each year——which, as Popula notes are “ irrevocable, highly visible, life-changing surgeries… [many of which] are motivated by body dysphoria, peer pressure, and invidious internalized notions about race and ethnicity.”
Moreover, tens of thousands of life-altering genital surgeries were also being performed on vulnerable children every year in American hospitals, decisions they were in no position to comprehend and which many, perhaps most, would later come to regret. In fact, studies how that if just left alone, plenty of them will identify as the correct gender on their own.
Although it is little known to the public, for over 40 years children as young as age five have quietly been given hormone blockers by their pediatricians.
It's it time we call a HALT to this madness?
Oh wait. Sorry..
The first graph was bout cisgirls getting elective cosmetic surgeries. The second was about nose jobs. The third was about Intersex Genital Mutiliation. And the last was about ciskids treated for precocious puberty.
(Only 282 transkids had top surgery in 2021--that's .12% of all cosmetic surgeries on teens).
My bad. Go back to your fixation on gender transitions. Never mind...
I have come to a few core principles on this issue.
1. Withholding gender affirming care from a kid with gender dysphoria causes harm. Kids with gender dysphoria should be given affirming care.
2. Providing gender affirming care to a kid without gender dysphoria causes harm. Kids without gender dysphoria should not be given affirming care.
3. #2 is happening more than #1.
4. Most people align with their tribe and ignore where their position causes harm.
5. Kids need professionals who are well trained on the best science to determine if they have gender dysphoria. Because healthcare professionals should first do no harm, they should be skeptical of a kids assertion of gender dysphoria just as they would be skeptical of a kid assertion of any other self diagnosis.
6. Kids need others parents, teachers, community leaders, politicians to do what is in the kids best interest and put their politics aside. This goes for both the right and the left.
New subscriber here. Excellent essay. It will not be popular in certain circles, where " a robust culture of anathematizing anyone who says the “wrong” thing on this topic" is the obligatory ritual.
The (non) reversibility of GnRHa treatments is a developing story. A decade ago it would have been correct to say that little or no evidence on non-reversibility existed- as Matthew points out, this was mostly because the question had not been studied. Can puberty blockers affect the brain? Studies are beginning to suggest that this is very likely. For example, one recent study from Columbia U. published in Neuropsychopharmacology (Anacker et al 2021) found:
"Chronic leuprolide treatment in mice has profound effects on female behaviors that are commonly interpreted as depression-like, as well as on neural activity in the hippocampus—a brain region crucially involved in stress processing, depression, and cognition."
If progressives want to "follow the science", the science appears to be evolving. In the UK, which, unlike the US does not have a for-profit model of clinic based care, NHS no longer asserts that GnRHa's are reversible or safe. The UK has shut down its "Gender Clinics" while in the US they continue to proliferate.
Folks with a long-ish memory will recall that Matt linked opioids and gender-affirming care back in May '22 as examples of an enterepenurial health care system that is incentived to overtreat.
Those of us withiout a long memory have Google, soon to be supplanted by BingGPT.
I find it interesting we accept that we shouldn’t let folks between 14 and 18 make major decisions. I can certainly see the need for parental sign off for some things (including irreversible medical procedures) even if it’s complicated by parents potentially being shitty. But in general in the US we should be giving teenagers more agency not less, I know the brain isn’t fully developed but infantilizing teens doesn’t seem to be the right call. I’d love to see lower voting and drinking ages in particular.
I talk to my teenager sometimes about similar concerns expressed by Matt (largely because I went through a phase where I felt I was more like a boy than a girl and dressed like a boy for about a year and I am horrified at the thought I would have taken hormones or done something permanent) and she tells me to stop listening to so many podcasts, there aren’t that many trans people and no one really cares one way or the other. On the other hand, she says everyone is high all the time, drugs are plentiful and easy to disguise, and hardcore porn and extreme violence are accessible to any 10-year-old with an iPhone. Seems bad, as Matt would say.
I still think my concerns are valid and that she lives in a red-state-large-public-school bubble where the number of trans kids is very low, but I take her point about the significance of it relative to other potential threats to the well-being of young people.
The point is the salience. What you're describing is not an issue of gender identity but accommodating a disability by making their struggles with gender dysphoria something everyone else has to deal with. If a trans person is as comfortable with their gender identity as you are with being male, it's not a problem.
I made a clear distinction between simply being trans (or non-binary), which is not a disability, and suffering from gender dysphoria so severe to cause anguish by being misgendered. This has nothing to do with transpeople (or non-binary) living their lives as they see fit.
Excellent piece. Trans people face tremendous challenges just living their daily lives, from workplace discrimination to street harassment, up to the point of being physically attacked simply for existing in the same space as a transphobe.
These issues are huge, whereas the right to use a female locker room is incredibly minor. Yet we spend way more time fighting over the latter than the former (for the record, I am a cis woman, consider myself very supportive of trans rights, and 100% oppose having to share a locker room with penis-having strangers).
I think this is exacerbated by young, otherwise privileged trans people so prevalent on Twitter. Locker rooms, high school sports, and growing into an attractive adult feel like very pressing issues, as opposed to actually fearing for your life in a deeply conservative area.
I do wish there were some trans Slow Boring commentators. I have seen a lot of cis people on here make what I consider to be very backwards views. “Trans people are deluded.” Okay, but what does that really mean? Until not so long ago, homosexuality was considered a mental illness. Talking to my adult trans friends, who are well past the age of possible “social contagion,” as soon as they were old enough to know what gender was, they realized they were in the wrong body and furthermore, they had to keep it a secret from adults. They could not be therapized or converted to the “right” identity.
This is a really good post. I was talking to my Mom about trans stuff the other day and like she has good-faith objections to stuff like gender neutral bathrooms, the phrase "birthing-persons" etc.
I think people should be able to voice those without getting called a bigot. Especially when that person agrees with all the major stuff like protection from workplace discrimination
I'm interested in your throwaway line about refusing to join in on "complaining about elective pronouns and the contemporary progressive vocabulary of cis-versus-trans." I mostly agree with your article, both in the general solidarity with the oppressed and in the importance of looking at the deeper issues. But I think the pronoun and "cis-versus-trans" arguments are some of those deeper issues that bear scrutiny. I just read your article about the real purpose of inclusive language, and think your conclusions apply here.
Insisting on the use of neologisms like "cis", or establishing new social rituals centered on pronouns, do not seem to have anything to do with dignity or inclusion. I see them as a new etiquette designed to separate people out and punish people who do not keep up and comply. It has never been clear why it matters that I refer to myself as "cis" or carefully select pronouns for people who claim ambivalence about their gender. I am simply aware that some people will be very angry with me if I do not. If doing so somehow gives dignity to those without it, I would like to see someone make that argument persuasively and not judgmentally.
It is probably unhelpful that the genuinely cruel do focus on these issues, but I do not think that means only cruel people resent being asked to engage in these new etiquette rituals.
The point of the word cisgender is to make communication clearer. Just like we have words like “straight” and “heterosexual” to describe people who are attracted to the opposite sex.
It's not that I object to the existence of the word, and it may well make sense in some contexts. It seems to have come out of academia and been used to denote "not trans" in writing where a term for that may have been handy. However, I never heard it until a few years ago and as of yet I have never used it to describe myself. I have simply never needed to reach for a term like that to make communication clearer.
The only times I've heard it in reference to myself have been weird circumstances where someone else uses it, often not in a particularly nice way. I also happen to know that lots of folks do not know what it means, and so it certainly does not make communication clearer for them when they hear it. It just marks them out as people not in the know and sets up a weird conversation if they ask about it.
Seems like a word that could safely be left in academia.
This piece has been making rounds in the Ezra Klein subreddit, so I'm gonna share one of the comments on the subreddit about this article.
dosamine: I think [this article is] a good piece, in that it seems quite clear-eyed about the reality of what's at stake, and generally does not adopt the overly credulous framework of more terfy folks. However I have a few criticisms.
First, it's been striking to me in all of the articles and discussions that get shared about this topic, there is a constant lack of data to support the idea that this is a problem, that large numbers of children are medically transitioning, as opposed to socially transitioning. The "social contagion" argument is pretty much always advanced from anecdote, with no demonstration made that there were any increases in medicalization resulting. I can understand folks hear anecdotes and get worried, but it doesn't seem like too much to ask that they push for data-gathering before affirmatively suggesting there's a massive, systemic problem.
Second, if we're worried that a mental health crisis among teens is being overlooked, then the proper response seems to be... bringing more attention and reporting to the mental health crisis. Which again, would involve spending very little time talking about trans issues because there's no data to support the idea this is a contagion with massive deleterious effects on the health of children. I just don't think it makes any sense to argue that trans-affirming healthcare blocks needed action on mental illness in kids, since again, we're talking about an extremely small group of people.
Third, it has seemed very clear for a while that this conversation about medical regret, parental consent, medical providers maximizing customer bases, and "irreversible damage" should be much bigger. It knocked me off my feet to learn that intersex children will often have surgeries performed on them very soon after birth in order to make their external presentation conform to a binary sex, and that this is usually uncontroversial among doctors and parents. That's just one example. Looking at comparative regret rates for surgeries, understanding that cis people will often get exactly the same hormone treatments and surgeries trans people ask for with basically no gatekeeping, the fact that dentists for example will routinely recommend treatments that aren't needed solely in order to increase revenue, all of it raises huge questions about whether any of us are ever reasonably informed enough to consent, whether our systems are too messed up to make consent meaningful, whether enough data really exists, and so on. Yglesias alludes to this when he talks about how opioids have been pushed as a cheap easy option compared to more rigorous physical therapy. But I think if you really dive into that, you have to accept that this conversation is so huge that focusing on an incredibly tiny minority of trans people as the place where you're going to ask difficult questions makes no sense. And I don't know how you can look at that and not see that the reason why people do that is not concern about predatory doctors or trying to shield children from physical damage. It's discomfort with gender non-conformity.
Minors undergo irreversible medical procedures all the time--nose jobs, abortions, circumcisions. Whether to take hormone blockers or get surgery is obviously a big decision for teens and their parents, but it is not a question for public policy, and it’s frankly bizarre for pundits to opine so strongly on a topic that is fundamentally niche, personal, and irrelevant to policy.
I should say “should be irrelevant to policy.” States are also passing abortion restrictions but progressives don’t take seriously the idea that governments should be involved in the decision.
I kind of agree with you and kind of don’t. On abortion, you have a big decision either way. If you don’t have an abortion, you will have a baby. There’s no “wait a few years and see how you feel” path.
I oppose circumcision, and I would be fine preventing people from getting cosmetic surgery until they are 18.
Most of us would agree that our teenage years were our most emotionally vulnerable, and vainest. I think we’d all agree we also had terrible judgment. The idea that you will grow up to be an unattractive adult because your body will look too masculine or feminine may in fact feel like the end of the world, and probably won’t be weighed properly against something like possible loss of fertility.
Maybe you’ll regret it, maybe you won’t. I have no idea if I would be supportive if my teen child wanted to go on hormone blockers--could be a complex call. I’m quite sure I would not want the government weighing in though. As a policy question, circumcision should be 1000x more controversial--babies aren’t consulted about whether they want the permanent change in sexual function.
One of the best articles I have read on the subject on both sides of the Atlantic. I shall use it when I hit the wall discussing with some friends who are more susceptible than I am to blind dog whistles.
And it won my subscription, even if I spend now so much on Substack that I could finance a small gaming problem. But brains that think without blinders need to be supported.
I don't have anything interesting to add, but just want to say that this was really thoughtfully written--one of your best pieces yet. I really appreciate that while you're skeptical of how progressives are approaching this issue, you take pains to affirm the importance of shared dignity and compassion as a starting point for these conversations.
I'm often in the uncomfortable position of being a little exasperated with the dogmatism of my fellow progressives, but then also feeling completely repulsed when I try to find alternative voices to help me figure out what I really think, only to find that they are ALL essentially the "just asking questions" guy. Like, are my only options really progressive Twitter or the so-called Intellectual Dark Web (ew)? Slow Boring provides what I think of as respectful skepticism, and even when I disagree with you, I always find it helpful to read.
Re-watch Dopesick mentally overlaying 'trans' and 'COVID' on 'Oxy'.
Optimistically, I look forward to a civilization with two tremendous docuseries being dropped in 2029: COVIDsick and Transsick.
Great article Matt. The analogy to pain medication was brilliant. Thank you.
I am an Ob-Gyn resident. I actually somewhat regularly am involved in providing gender affirming care to adults. And it’s something I do happily without reservation, as the patients have been appropriately counseled and transitioned for several years (many times >5 years) prior to under going surgery that removes their reproductive capacity.
I have significant reservations about any medical transition in teens, especially when combined with puberty blockers. I do not think they can provide consent. This is not a small issue.
Puberty blockers prevent sexual maturity, this is more than just physical changes, it is a critical period of mental and psychological development. Additionally, puberty blockers followed by opposite sex hormones does not allow for reproductive maturity, severely and even eliminating fertility options. It can also make gender affirming surgery very difficult down the road and even limit pleasure from intimacy.
I do not believe any adolescent had the ability to adequately consent to these life changing decisions. I also do not believe they have had enough time to adequate distinguish between sexuality and gender, before they have even reached puberty.
Moreover, in medicine, we have historically been so momentously wrong and ethically challenged when limiting or inhibiting fertility in patients with questionable ability to consent.
I worry that the field (peds endocrinology) has not had to reconcile the ethics of impinging on fertility and I worry for these patients 15 years from now. I have no doubt there will be many class action lawsuits and the patients should win.
And the evidence that medical transition is needed to avoid severe mental health outcomes is very weak. Medical transition vs non-medical gender affirming care in teenagers has never been tested adequately.
If a child has mental health problems, the idea that physically transitioning will cure them seems asinine. What are the mental health problems? "Mental health" is nebulous and in many cases is something that AT BEST can barely be managed with incredible amounts of social and medical support. Using mental health as a righteous excuse to carpet bomb society with physically and chemically transitioned children sounds like a great way to ensure work for unscrupulous doctors and drug companies. And this after hundreds of thousands died - and millions were affected - under the lie of compassionate pain management.
In fact, gender affirming top-surgery for teens, particularly those assigned female at birth (AFAB), had once been fairly rare, but by 2020 it had become increasingly common. A report published by The National Institutes of Mental Health (NIMH) would report that,4,830 teens had breast implants in 2021, while an additional 4,700 had breast reductions. That’s was almost 10,000 yearly and it was growing each year. It had even become common among some teens to ask for breast surgery as a “graduation present” upon completing high school.
Such procedures are not limited to bodies. Other teens are having surgeries to their faces to make them look more stereotypically feminine—30,000 each year——which, as Popula notes are “ irrevocable, highly visible, life-changing surgeries… [many of which] are motivated by body dysphoria, peer pressure, and invidious internalized notions about race and ethnicity.”
Moreover, tens of thousands of life-altering genital surgeries were also being performed on vulnerable children every year in American hospitals, decisions they were in no position to comprehend and which many, perhaps most, would later come to regret. In fact, studies how that if just left alone, plenty of them will identify as the correct gender on their own.
Although it is little known to the public, for over 40 years children as young as age five have quietly been given hormone blockers by their pediatricians.
It's it time we call a HALT to this madness?
Oh wait. Sorry..
The first graph was bout cisgirls getting elective cosmetic surgeries. The second was about nose jobs. The third was about Intersex Genital Mutiliation. And the last was about ciskids treated for precocious puberty.
(Only 282 transkids had top surgery in 2021--that's .12% of all cosmetic surgeries on teens).
My bad. Go back to your fixation on gender transitions. Never mind...
I have come to a few core principles on this issue.
1. Withholding gender affirming care from a kid with gender dysphoria causes harm. Kids with gender dysphoria should be given affirming care.
2. Providing gender affirming care to a kid without gender dysphoria causes harm. Kids without gender dysphoria should not be given affirming care.
3. #2 is happening more than #1.
4. Most people align with their tribe and ignore where their position causes harm.
5. Kids need professionals who are well trained on the best science to determine if they have gender dysphoria. Because healthcare professionals should first do no harm, they should be skeptical of a kids assertion of gender dysphoria just as they would be skeptical of a kid assertion of any other self diagnosis.
6. Kids need others parents, teachers, community leaders, politicians to do what is in the kids best interest and put their politics aside. This goes for both the right and the left.
New subscriber here. Excellent essay. It will not be popular in certain circles, where " a robust culture of anathematizing anyone who says the “wrong” thing on this topic" is the obligatory ritual.
The (non) reversibility of GnRHa treatments is a developing story. A decade ago it would have been correct to say that little or no evidence on non-reversibility existed- as Matthew points out, this was mostly because the question had not been studied. Can puberty blockers affect the brain? Studies are beginning to suggest that this is very likely. For example, one recent study from Columbia U. published in Neuropsychopharmacology (Anacker et al 2021) found:
"Chronic leuprolide treatment in mice has profound effects on female behaviors that are commonly interpreted as depression-like, as well as on neural activity in the hippocampus—a brain region crucially involved in stress processing, depression, and cognition."
If progressives want to "follow the science", the science appears to be evolving. In the UK, which, unlike the US does not have a for-profit model of clinic based care, NHS no longer asserts that GnRHa's are reversible or safe. The UK has shut down its "Gender Clinics" while in the US they continue to proliferate.
Folks with a long-ish memory will recall that Matt linked opioids and gender-affirming care back in May '22 as examples of an enterepenurial health care system that is incentived to overtreat.
Those of us withiout a long memory have Google, soon to be supplanted by BingGPT.
https://www.slowboring.com/p/overtreatment-in-american-health
I find it interesting we accept that we shouldn’t let folks between 14 and 18 make major decisions. I can certainly see the need for parental sign off for some things (including irreversible medical procedures) even if it’s complicated by parents potentially being shitty. But in general in the US we should be giving teenagers more agency not less, I know the brain isn’t fully developed but infantilizing teens doesn’t seem to be the right call. I’d love to see lower voting and drinking ages in particular.
I talk to my teenager sometimes about similar concerns expressed by Matt (largely because I went through a phase where I felt I was more like a boy than a girl and dressed like a boy for about a year and I am horrified at the thought I would have taken hormones or done something permanent) and she tells me to stop listening to so many podcasts, there aren’t that many trans people and no one really cares one way or the other. On the other hand, she says everyone is high all the time, drugs are plentiful and easy to disguise, and hardcore porn and extreme violence are accessible to any 10-year-old with an iPhone. Seems bad, as Matt would say.
I still think my concerns are valid and that she lives in a red-state-large-public-school bubble where the number of trans kids is very low, but I take her point about the significance of it relative to other potential threats to the well-being of young people.
The point is the salience. What you're describing is not an issue of gender identity but accommodating a disability by making their struggles with gender dysphoria something everyone else has to deal with. If a trans person is as comfortable with their gender identity as you are with being male, it's not a problem.
Do you consider homosexuality to be a disability?
I remember these EXACT same complaints. “Be gay, just don’t rub it in our faces by kissing in public. It’s different when straight people do it.”
I made a clear distinction between simply being trans (or non-binary), which is not a disability, and suffering from gender dysphoria so severe to cause anguish by being misgendered. This has nothing to do with transpeople (or non-binary) living their lives as they see fit.
Excellent piece. Trans people face tremendous challenges just living their daily lives, from workplace discrimination to street harassment, up to the point of being physically attacked simply for existing in the same space as a transphobe.
These issues are huge, whereas the right to use a female locker room is incredibly minor. Yet we spend way more time fighting over the latter than the former (for the record, I am a cis woman, consider myself very supportive of trans rights, and 100% oppose having to share a locker room with penis-having strangers).
I think this is exacerbated by young, otherwise privileged trans people so prevalent on Twitter. Locker rooms, high school sports, and growing into an attractive adult feel like very pressing issues, as opposed to actually fearing for your life in a deeply conservative area.
I do wish there were some trans Slow Boring commentators. I have seen a lot of cis people on here make what I consider to be very backwards views. “Trans people are deluded.” Okay, but what does that really mean? Until not so long ago, homosexuality was considered a mental illness. Talking to my adult trans friends, who are well past the age of possible “social contagion,” as soon as they were old enough to know what gender was, they realized they were in the wrong body and furthermore, they had to keep it a secret from adults. They could not be therapized or converted to the “right” identity.
This is a really good post. I was talking to my Mom about trans stuff the other day and like she has good-faith objections to stuff like gender neutral bathrooms, the phrase "birthing-persons" etc.
I think people should be able to voice those without getting called a bigot. Especially when that person agrees with all the major stuff like protection from workplace discrimination
I'm interested in your throwaway line about refusing to join in on "complaining about elective pronouns and the contemporary progressive vocabulary of cis-versus-trans." I mostly agree with your article, both in the general solidarity with the oppressed and in the importance of looking at the deeper issues. But I think the pronoun and "cis-versus-trans" arguments are some of those deeper issues that bear scrutiny. I just read your article about the real purpose of inclusive language, and think your conclusions apply here.
Insisting on the use of neologisms like "cis", or establishing new social rituals centered on pronouns, do not seem to have anything to do with dignity or inclusion. I see them as a new etiquette designed to separate people out and punish people who do not keep up and comply. It has never been clear why it matters that I refer to myself as "cis" or carefully select pronouns for people who claim ambivalence about their gender. I am simply aware that some people will be very angry with me if I do not. If doing so somehow gives dignity to those without it, I would like to see someone make that argument persuasively and not judgmentally.
It is probably unhelpful that the genuinely cruel do focus on these issues, but I do not think that means only cruel people resent being asked to engage in these new etiquette rituals.
The point of the word cisgender is to make communication clearer. Just like we have words like “straight” and “heterosexual” to describe people who are attracted to the opposite sex.
It's not that I object to the existence of the word, and it may well make sense in some contexts. It seems to have come out of academia and been used to denote "not trans" in writing where a term for that may have been handy. However, I never heard it until a few years ago and as of yet I have never used it to describe myself. I have simply never needed to reach for a term like that to make communication clearer.
The only times I've heard it in reference to myself have been weird circumstances where someone else uses it, often not in a particularly nice way. I also happen to know that lots of folks do not know what it means, and so it certainly does not make communication clearer for them when they hear it. It just marks them out as people not in the know and sets up a weird conversation if they ask about it.
Seems like a word that could safely be left in academia.
This piece has been making rounds in the Ezra Klein subreddit, so I'm gonna share one of the comments on the subreddit about this article.
dosamine: I think [this article is] a good piece, in that it seems quite clear-eyed about the reality of what's at stake, and generally does not adopt the overly credulous framework of more terfy folks. However I have a few criticisms.
First, it's been striking to me in all of the articles and discussions that get shared about this topic, there is a constant lack of data to support the idea that this is a problem, that large numbers of children are medically transitioning, as opposed to socially transitioning. The "social contagion" argument is pretty much always advanced from anecdote, with no demonstration made that there were any increases in medicalization resulting. I can understand folks hear anecdotes and get worried, but it doesn't seem like too much to ask that they push for data-gathering before affirmatively suggesting there's a massive, systemic problem.
Second, if we're worried that a mental health crisis among teens is being overlooked, then the proper response seems to be... bringing more attention and reporting to the mental health crisis. Which again, would involve spending very little time talking about trans issues because there's no data to support the idea this is a contagion with massive deleterious effects on the health of children. I just don't think it makes any sense to argue that trans-affirming healthcare blocks needed action on mental illness in kids, since again, we're talking about an extremely small group of people.
Third, it has seemed very clear for a while that this conversation about medical regret, parental consent, medical providers maximizing customer bases, and "irreversible damage" should be much bigger. It knocked me off my feet to learn that intersex children will often have surgeries performed on them very soon after birth in order to make their external presentation conform to a binary sex, and that this is usually uncontroversial among doctors and parents. That's just one example. Looking at comparative regret rates for surgeries, understanding that cis people will often get exactly the same hormone treatments and surgeries trans people ask for with basically no gatekeeping, the fact that dentists for example will routinely recommend treatments that aren't needed solely in order to increase revenue, all of it raises huge questions about whether any of us are ever reasonably informed enough to consent, whether our systems are too messed up to make consent meaningful, whether enough data really exists, and so on. Yglesias alludes to this when he talks about how opioids have been pushed as a cheap easy option compared to more rigorous physical therapy. But I think if you really dive into that, you have to accept that this conversation is so huge that focusing on an incredibly tiny minority of trans people as the place where you're going to ask difficult questions makes no sense. And I don't know how you can look at that and not see that the reason why people do that is not concern about predatory doctors or trying to shield children from physical damage. It's discomfort with gender non-conformity.
Minors undergo irreversible medical procedures all the time--nose jobs, abortions, circumcisions. Whether to take hormone blockers or get surgery is obviously a big decision for teens and their parents, but it is not a question for public policy, and it’s frankly bizarre for pundits to opine so strongly on a topic that is fundamentally niche, personal, and irrelevant to policy.
I mean, it clearly is relevant to policy — various states are passing various laws expanding or curbing access to these procedures.
I should say “should be irrelevant to policy.” States are also passing abortion restrictions but progressives don’t take seriously the idea that governments should be involved in the decision.
I kind of agree with you and kind of don’t. On abortion, you have a big decision either way. If you don’t have an abortion, you will have a baby. There’s no “wait a few years and see how you feel” path.
I oppose circumcision, and I would be fine preventing people from getting cosmetic surgery until they are 18.
Most of us would agree that our teenage years were our most emotionally vulnerable, and vainest. I think we’d all agree we also had terrible judgment. The idea that you will grow up to be an unattractive adult because your body will look too masculine or feminine may in fact feel like the end of the world, and probably won’t be weighed properly against something like possible loss of fertility.
Maybe you’ll regret it, maybe you won’t. I have no idea if I would be supportive if my teen child wanted to go on hormone blockers--could be a complex call. I’m quite sure I would not want the government weighing in though. As a policy question, circumcision should be 1000x more controversial--babies aren’t consulted about whether they want the permanent change in sexual function.
I think it’s fair to err on the side of “do no harm.” Growing up into an ugly adult simply isn’t as big a deal as becoming infertile.
I do agree with you on circumcision.
One of the best articles I have read on the subject on both sides of the Atlantic. I shall use it when I hit the wall discussing with some friends who are more susceptible than I am to blind dog whistles.
And it won my subscription, even if I spend now so much on Substack that I could finance a small gaming problem. But brains that think without blinders need to be supported.