Europe Becomes More Cautious About Pediatric Gender Medicine While California Doubles Down
Meanwhile, the case of Ilya Shapiro is a bad sign for free speech, the legal profession, and the future of higher education
For our country to be a nation of laws, lawyers must, among other things, be capable of understanding the legal reasoning of politically opposing scholars and jurists. And they must grasp the difference between opinions and harm. When law schools fail to make this distinction, freedom of speech and conscience are at risk, and so are student and faculty well-being. The recent saga of conservative legal scholar Ilya Shapiro at Georgetown University illustrates the problem. You can read more in my recent article for Psychology Today.
In related news, the U.K.’s Gender Clinic (Tavistock) is shutting down after a recent report declared that its services were “not safe” for children. The report called for more research on the use of medications referred to as “puberty blockers” for children who feel their gender is not consistent with their biological sex.
How is this related to the inability to tolerate opposing views?
Opposition to the “affirmation” and medicalization of transgender identities in childhood is viewed by trans activists as harmful in and of itself. And repercussions for holding such views can be severe. Stella O'Malley, an Irish psychotherapist and founder of Genspect, an organization established to advocate for better quality pediatric care for those who experience gender-related distress, told me that some psychotherapists have been referring children with gender dysphoria to the Tavistock without engaging in any psychotherapy because they are afraid that if they provide exploratory therapy rather than merely affirming children’s declarations of a new gender identity, they put their practices at risk. The same thing is happening in the U.S., where in some states, psychotherapists are afraid they could lose their licenses to practice if they explore other psychological issues rather than “affirming” children’s new felt genders.
The Tavistock clinic saw only a few hundred patients ten years ago. In the last year, they had more than 5,000 referrals. Children in both the U.K. and the U.S. have been rushed into medical transition rather than spending time exploring other psychological issues. (Read Grace Lidinsky-Smith’s account for a first-person narrative of transitioning and de-transitioning.)
Proponents of “puberty blockers” speak about the gonadotropin-releasing hormone agonists as if they are merely a “pause button” on puberty for children with gender identity issues. But they are not FDA-approved for that use, there has been no research to determine that they are safe for use in children whose pubertal development would otherwise unfold on time, and dangerous side effects are coming to light. In addition, as Dr. Hilary Cass, who authored the recent report in the U.K., warned, “we do not fully understand the role of adolescent sex hormones in driving the development of both sexuality and gender identity through the early teen years, so by extension we cannot be sure about the impact of stopping these hormone surges on psychosexual and gender maturation.”
Cass highlighted that the years of data gathered on children who went on to medically transition revolved around the small proportion of boys with early-childhood-onset gender dysphoria who did not desist once they reached early puberty. (Most children with gender dysphoria eventually “desist” –– they become comfortable with their natal sex.) The risks associated with medicalizing gender transition in childhood have been considered reasonable for this small subset of boys, who were historically screened to rule out other psychological disorders, because of the high likelihood that they would eventually seek transition with or without pediatric gender medicine. Halting their natural pubertal development and then providing them with the cross-sex hormones that mimic female pubertal development prevents their masculinizing development, making it easier for them to present as feminine later in life.
But these risks are not reasonable for children whose gender identity issues develop later in childhood. Those children tend to have other psychological issues, will not necessarily persist in their “trans” gender identity if that identity is not “affirmed,” and, as Cass noted in the report, there is “no way of knowing whether, rather than buying time to make a decision, puberty blockers may disrupt that decision-making process.”
A further risk, she wrote, is that “adolescent sex hormone surges may trigger the opening of a critical period for experience-dependent rewiring of neural circuits underlying executive function (i.e. maturation of the part of the brain concerned with planning, decision making and judgement). If this is the case, brain maturation may be temporarily or permanently disrupted by puberty blockers, which could have significant impact on the ability to make complex risk-laden decisions, as well as possible longer-term neuropsychological consequences.”
As journalist Lisa Selin Davis told me, “France, Finland, Sweden, and the U.K. have all acknowledged that there’s a new cohort of young people seeking sex changes,” and it is becoming clear that this cohort, mostly girls, is very different from the boys whose gender dysphoria began in early childhood. In the U.S., however, where gender medicine has become hyperpolarized, even the term “Rapid Onset Gender Dysphoria” is considered offensive by some. Abigail Shrier’s book, Irreversible Damage: The Transgender Craze Seducing Our Daughters, was an early warning of a social contagion that seems to have become even more prevalent since 2020 when her book was published.
Today, parents in some states fear that if they don’t “affirm” their children’s new felt genders, they will run into issues with the department of child protective services –– or worse, they are told that their children will commit suicide. (Something that is not borne out by the data.) Meanwhile, California is poised to become a “sanctuary state” for any parent who wants to medically transition a child without the other parent’s consent, and for runaway children who want access to pediatric gender medicine without either parent’s consent.
All of this runs counter to what the research indicates about the safety and efficacy of pediatric medical transition. But when other states threaten parents with charges of child abuse if they provide such treatment for their children, it becomes difficult for proponents of these treatments to reflect on potential harms. Legitimate concerns can seem like a smokescreen for ideological rather than thoughtful opposition, which leads to demonizing anyone who raises alarms. At the same time, those opposed to medicalizing gender in childhood can tend to see those who push for it as willing to inflict harm on children in the service of some ulterior motive rather than recognizing that the vast majority are trying to alleviate these children’s suffering.
I moderated a conversation (video below) about the aggressive approach we see in the U.S. (currently referred to as “gender affirmation”) and why, when Europe is becoming more cautious, the U.S. is not paying attention to the same research.
For more about gender issues, follow each of the participants in that roundtable discussion: Ben Appel, Buck Angel, Corinna Cohn, Joseph Burgo, Leor Sapir, and Lisa Selin Davis.
More to come…