Just a few years ago, the LGBTQIA movement seemed unstoppable. But in a deep dive, the New York Times’ Nicholas Confessore examines why transgender rights movement might prove to have over-reached.
Until this week’s decision by the US Supreme Court that upheld a Tennessee ban on puberty blockers, hormone treatment or surgery for minors seeking to change their birth gender, the LGBTQIA movement had a string of victories, Confessore recalled. “Tailoring its message to reach skeptical audiences, careful to ride near the crest of shifting public sentiment, it pursued incremental legal and regulatory wins that, ultimately, sparked deep social change. Beginning in the 2010s, gay people won the right to marry and, along with trans people, serve openly in the military. The movement defeated “bathroom bills” aimed at trans people in states like North Carolina and Texas, persuading even some Republicans that such measures were unnecessary and cruel. Just five years ago, the Supreme Court ruled that employees could not be fired for being gay or transgender.”
In a detailed examination of the politics and science surrounding the decision, that mirrors the decision that overturned Roe v. Wade in returning decision-making power to the states, Confessore says progressives chose a “fraught issue, whether children have a constitutional right to treatments that halt and redirect their physical adolescence.”
The NYTimes piece is worth reading in full, for its dissection of the competing factions of the left driving the transgender rights campaign, as well as the effect of Trump’s re-election and the exploitative politicisation of transgender issues on the right.
But perhaps the most critical part of the history is the impact of US unregulated medicine, which moved towards a position that an adolescent’s self-declared gender identity was all that was needed for a doctor to use puberty blockers, hormones or even surgery. “In the relatively small community of pediatric gender medicine, physicians increasingly advocated a ‘gender-affirming’ approach, in which clinicians should generally defer to a child’s self-declared identity. Some doctors, citing the risk of suicidal thoughts and behavior among trans youths, argued that failing to affirm a child’s expressed gender would put their life in danger. “We often ask parents, ‘Would you rather have a dead son than a live daughter?’” Johanna Olson-Kennedy, one of the country’s leading gender physicians, told ABC News. In 2018, the gender-affirming model was endorsed by the American Academy of Pediatrics, one of the country’s most influential medical groups.
“By then, practitioners like Olson-Kennedy were arguing that trans-identifying children – even those whose dysphoria might be entwined with other mental-health problems – didn’t need extended psychological assessments any more than trans adults did.”
This approach was more radical than the “Dutch protocol” which had some safeguards – for example, an extended period of medical care and examination first – although a gender-critical position would be that that was not sufficient. Trans activists were more radical in turn. “Activists on the left believed that achieving trans rights required a more fundamental social reimagining of sex and gender. There was less and less room for competing views. One person involved in the North Carolina campaign described increasingly tense conversations around the doctrine of self-ID and single-sex spaces. Some argued that women had no right to feel uncomfortable sharing a prison cell or a locker room with a trans woman: Such concerns only validated the trope that trans women were threatening.”
Meanwhile, the science behind gender changing medicine was proving to be thin. “In 2020, citing ‘limited’ research data, Finland’s health agency removed surgery from the treatment protocol for minors with dysphoria and restricted the use of blockers and hormones. In February 2021, an effort to replicate the Dutch studies at Britain’s Tavistock gender clinic failed, finding that puberty blockers had little effect on adolescents’ dysphoria or thoughts of self-harm.
“The following month, the British National Institute for Health and Care Excellence (NICE) issued a pair of systematic reviews — studies that pool the literature on a treatment and grade the quality of the collected evidence. A pillar of the discipline known as evidence-based medicine, systematic reviews are meant to ensure that doctors’ recommendations are based on objective evidence, not ‘habit or misguided expert advice,’ according to Gordon Guyatt, a professor of health sciences at McMaster University in Canada and a formative figure in the field.
“But research on gender-affirming care, NICE’s analysis showed, provided only ‘very low certainty’ evidence that puberty blockers or hormone treatments actually improved patients’ dysphoria. The consensus repeatedly cited by L.G.B.T.Q. advocacy groups in the United States relied heavily on small-scale observational studies, patient surveys and the professional experience of gender clinicians themselves — a category that evidence-based medicine ranks as least reliable.”
Possibly the strongest argument for gender change treatments was the question, “Would you rather have a dead son than a live daughter?” mentioned earlier. It relied on what turns out to be an assumption, or the anecdotal evidence of clinicians rather than a more reliable evidence base. This was the crux of the Tennessee hearing in the Supreme Court.
Pressed on the longstanding claim that gender-affirming care prevented dysphoric teenagers from killing themselves, [the first openly transgender lawyer to appear before the court, Co-Director of the ACLU’s LGBT & HIV Project Chase] Strangio conceded the point. “There is no evidence,” he told the court, “that this treatment reduces completed suicide,” adding that “completed suicide, thankfully and admittedly, is rare.”
As the Tennessee case and a similar one in Alabama wound through the US Court, systemic gaps in the World Professional Association for Transgender Health (WPATH) standards were revealed from thousands of WPATH emails and documents examined in the Alabama case court process.
“‘While we value clinical expertise, the battle for legitimacy is being fought in controlled studies,’ Eli Coleman, chairman of [WPATH’S recent standards] SOC-8 team and a psychologist, wrote to colleagues in 2023 as Tennessee and other states were preparing to approve their bans. ‘All of us are painfully aware that there are many gaps in research to back up our recommendations.'”
SOC-8 had asserted that “a systematic review regarding outcomes of treatment in adolescents is not possible.” Alabama’s legal filings, though, claimed that WPATH had tried to squelch some of its own findings on the question, fearing that they could be wielded against the expansion of transition care.”
The scientific basis for transgender medicine is still being examined. Hilary Cass, whose report caused the UK to close its Tavistock clinic and put a hold on the treatment of new adolescent patients, is quoted as taking a cautious middle position. “Cass has stressed her belief that some dysphoric young people will most likely benefit from transitioning before adulthood — the problem is that doctors cannot yet reliably identify which ones. An unquestioning approach to gender-affirming care, Cass has argued, is precisely the wrong way to handle young people with a more flexible view of gender than earlier generations. ‘It only becomes a challenge if we’re medicalizing it, giving an irreversible treatment, for what might be just a normal range of gender expression,’ she told The Times last spring.”
In addition to How the Transgender Rights movement bet on the Supreme Court and lost, the NY Times has published two opinion pieces with opposite viewpoints by queer authors.
M Gessen argues that the Supreme Court has ignored transgender team realities in The Supreme Court’s blindness to Transgender Reality
Andrew Sullivan argues that the excesses of the transgender movemnet threatens gay rights in How the Gay Rights movement radicalized and lost Its way
A key study that informed the Finland response: https://mentalhealth.bmj.com/content/27/1/e300940
Australian study that establishes significant co-morbidity data https://pubmed.ncbi.nlm.nih.gov/33510668/