‘State murder of kids’? Progressives’ narrative on treatment bans for transgender youth is only preventing any progress
To anyone living outside the West, hearing words like hormone blockers, demiboy, or SRS (sex reassignment surgery) come from the mouth of an eyeliner-clad 14-year-old boy on TikTok feels like a fever dream.
Meanwhile, in the US, it’s a topic of legislation.
In April this year, Arkansas became the first state to ban medical intervention for transgender minors. Tennessee followed suit and established its own ban on hormone blockers, which is going into effect this July. Over a dozen other states are floating similar proposals, and boy (girl? they?), has this become a controversial debate, with some progressives even calling these bans the legislated “state murder of kids.”
I have been thinking abt “raising concerns” & “just asking question,” common framings lately.
“Raising concerns” abt if a 13-yr-old kid ought to be killed by the state? That trans ppl ought to be denied care? No. It’s dangerous. https://t.co/xjE70rH4KP
— Dr. Steven W. Thrasher (@thrasherxy) April 8, 2021
🚨If it becomes a felony to provide life-saving treatment to trans kids then the state is essentially facilitating the murder of trans youth. This is terrifying. 🚨 https://t.co/qIKkOTsmgt
— Chase Strangio (@chasestrangio) October 31, 2019
What do hormone blockers – also known as puberty blockers – have to do with murder though? What even are hormone blockers in the first place? Well, hormone blockers, also known as gonadotropin-releasing hormone (GnRH) agonists, are generally used to prevent the body from producing sex hormones, in particular, to treat conditions such as prostate cancer, breast cancer, endometriosis, and even precocious puberty in children.
In the last few years, hormone blockers have been used off-label to prevent transgender children from going through puberty. Studies have found that off-label use of GnRHs in America has more than doubled in recent years.
This statistic may shock some who would consider puberty a vital part of our biological process, and therefore potentially dangerous to prevent.
However, many progressive activists, media figures, and politicians claim that this off-label care is not only safe, but the only moral medical option for children. Kate Oakley, the state legislative director for the Human Rights Campaign, told ABC News that hormone blockers are “life-saving” measures and to oppose them is to “invalidate” transgender people. The assertion of course being that any child who is not given gender-affirming care may or will commit suicide, and that this risk greatly outweighs any potential downsides of blocking puberty, with some even suggesting the effects of blocking puberty are entirely reversible.
Let me reiterate:
You know what’s reversible? Puberty blockers.
You know what isn’t? Puberty.
— Madi ♡ (@softdemidevil) April 16, 2021
Reminder: Puberty blockers are reversible, puberty is not.
— Nova🍓He/e (@RealityBent) May 25, 2021
Puberty blockers are not permanent. Loads of girls at my school were on them for very early heavy periods. This was in the 90s. I don’t remember hearing the outcry about how dangerous and evil they were then. Ah… But that’s because they were for cis kids so it was fine eh? 😶
— Jameela Jamil 🌈 (@jameelajamil) April 13, 2021
The only problem with this proposal is that it’s simply not supported by science.
It is true that transgender individuals face a suicide rate much higher than the average population, with one study suggesting 41% of transgender individuals may attempt suicide in their lifetime. Of course, this is a horrific statistic, but whether or not gender-affirming care reduces this chance of suicide is entirely unknown.
Preliminary research has shown minor self-reported benefits of hormone blockers, but the studies are nothing to make definitive statements over. Each one is mired with the same crisis of small sample sizes, lack of control group and self-reporting bias, such as Turban 2019 et al. which NBC reported as evidence for the success of GnRH usage. The study boasts a sample size of 20,619 transgender individuals, yet only 89 participants had ever used puberty blockers, and the study was entirely conducted through an online survey.
At present, any assertion that ‘we know’ hormone blockers prevent suicide and ‘we know’ they are reversable and safe, goes against the consensus of every major respected medical institution.
Let’s unpack the ‘surgery or suicide’ argument first.
GnRH research surrounding transgender individuals is hard to come by, so when activists approach the subject of gender-affirming care, often they will turn to positive outcomes in hormone treatments, facial feminization, or surgical reassignment surgery. The small body of research does contain summaries showing “positive reports” post-surgery. Often this will be presented as evidence that medical intervention is indeed effective at reducing suicide.
The problem with this analysis is many studies do not actually measure suicide post-surgery or even quality of life. They are simply reports on how much an individual “liked” their surgery, or if they are happy with their appearance afterwards. Which is inevitably impacted by self-affirmation bias and the fact that nearly every study on cosmetic surgery reports higher outcomes afterwards, regardless of whether the population tested was cisgender or transgender.
One of the highest reported positive outcomes post-surgery of transgender individuals is mammoplasty, i.e., the removal of the breasts in female to male transgender individuals. Coincidentally this is also one of the highest-rated cosmetic surgeries improving quality of life amongst non-transgender women as well.
If a woman had depression and reported a happy outcome with her mammoplasty, would we then assume that mammoplasty cures depression? Or is the more likely answer that positive reporting after mammoplasty is consistent among the entire population, depression or otherwise?
The potential to both misrepresent and politically interpret this data without context makes it very easy for activists to muddy the water on the debate around transgender medical treatments. Luckily, we don’t just have an amalgamation of low sample size studies to go off of.
The Obama administration commissioned a study on the efficacy of gender-affirming medical care during the former president’s time in office. The outcome of the study? They claim after a thorough review of the clinical evidence “there is not enough evidence to determine whether gender reassignment surgery improves health outcomes for Medicare beneficiaries with gender dysphoria.”
The US is not quite at the point of performing reassignment surgery on minors, but this lack of evidence for medical transitioning, in general, does not stop at SRS. Despite popular narratives, hormone blockers have a massive data gap when it comes to their long-term impacts, particularly on children in preventing puberty, i.e., the very thing activists are claiming we must do lest they commit suicide.
Last year, the UK’s NHS had to walk back their statement on puberty blockers initially claiming “the effects of treatment with GnRH analogues are considered to be fully reversible” (2019), which has now been adjusted to say “it is not known what the psychological effects may be. It’s also not known whether hormone blockers affect the development of the teenage brain or children’s bones.”
An adjustment which I’m sure totally bolsters all our confidence in the medical world’s analysis of this subject (not). Quite frankly it’s shocking the NHS ever made the statement about “full reversibility” before considering there have been exactly – zero – clinical trials with puberty blockers for transgender youth.
The truth is, as the data improves around hormone blockers, reassignment surgery, and suicide amongst transgender individuals, things simply get more confusing.
A correction of a recent Swedish study suggesting gender-affirming treatments resulted in positive outcomes, just last year had to re-analyze their data and adjust it to say actually they found no effect.
Studies of suicide rates worldwide showed China (0.16) had a lower transgender suicide rate than the United States (0.4), despite not nearly being as progressive on these issues. More so, the US has a lower suicide rate than Canada (0.43), which has been ranked significantly higher than the US on the 2020 social progress index.
All this data calls into question whether or not transitioning is preventing suicide, and stigma is causing suicide. Perhaps we must consider and explore that there may be a causal link between gender incongruence and suicidality rather than turning outwards at all cost.
Sadly, however, it may be a long time before we search for other explanations or solutions to people’s clearly difficult struggle with dysphoria. Questioning the popular approach to affirm and give surgery to those with gender incongruence will have you lambasted by popular culture and even compromise your career. Doctors have been fired from their job for simply refusing to use self-identified pronouns for patients.
It’s a terrifying dilemma we find ourselves in, which sadly is not the first in history. Ignaz Semmelweis was one of the first doctors to introduce hand disinfection standards in clinics in the 1800s. He was utterly persecuted by his colleagues, as they were mortified by the suggestion that their own actions were leading to the deaths of infants who were catching infections from their unwashed hands. Semmelweis was eventually ostracized to the point of being incarcerated in a mental hospital where he was beaten to death.
Never say there aren’t consequences for being right too early.
Worldwide, those who deny this trend or offer concerns are screamed down as monsters and killers, but may just find themselves vindicated as Semmelweis was.
It is true, with the data given, we do not know how to treat those with dysphoria. Perhaps affirming surgery is the answer. Perhaps only certain types are beneficial, and others harmful, such as blocking puberty. What is obviously true is that we need more research on this subject before making definitive claims, and certainly before making minors guinea pigs. Those who confuse modesty for bigotry help no one, and only make it impossible for us to progress in honest, life-saving conversation.
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