Oct 28, 2022 – Leor Sapir National Review
Guidance from the National Health Service is a welcome step toward sanity on transgender issues. So why is the U.S. doubling down?
The National Health Service (NHS) of England just released new draft guidance that abandons the “gender-affirmative” model for the treatment of gender-questioning youth. Recognizing the potential for harms and finding no evidence of benefits to “affirming” a minor’s self-declaration of transgender feelings with hormones, the NHS now recommends noninvasive psychotherapy as the default treatment for youth struggling with gender dysphoria. Puberty blockers will remain available for carefully selected cases, but only in regulated research settings. A similar fate likely awaits cross-sex hormones. The U.K. has never allowed transgender surgeries for minors and won’t allow them going forward.
The NHS went further, determining that “social gender transition” — which includes adults adopting a minor’s preferred name, pronoun, and gender role — is actually a form of psychosocial intervention with potentially serious risks. This reiterates an observation made by Dr. Hilary Cass, who recently served as president of the Royal College of Paedeatrics and Child Health — the U.K. counterpart to the American Academy of Pediatrics. The NHS commissioned Cass to evaluate the country’s main gender clinic, which was subsequently closed for — among other things — adhering to the “affirmative model” that “originated in the USA,” and for lacking proper child “safeguards.” Following extensive consultation with multiple stakeholders and a systematic review of evidence, Dr. Cass concluded that social transition should not be regarded as a “neutral act” of support but as a psychosocial intervention that can alter the course of a child’s development.
The NHS’s guidance is clear. It discourages all social gender transition in children, and — among adolescents — limits it strictly to those with diagnosed gender dysphoria who have undergone counseling to understand the risks and — importantly — have provided explicit informed consent. Regular, low-risk medical care does not typically require informed consent.
All of this holds special relevance not only for current debates over pediatric medicine, but more importantly, for debates over school policy in the United States.
As the U.S. doubles down on “gender-affirming care” on the advice of groups like the American Academy of Pediatrics, there are growing efforts to move the “affirmation” upstream into schools. This may not be obvious to most Americans owing to the abstract way the mainstream media and school districts discuss transgender issues, but the truth is that when schools adopt “safe and inclusive” policies for “transgender and gender nonconforming” students, the result is automatic social transitioning of students, often without parental knowledge or consent. What parents, teachers, and school-board members must know is that noble desires to be kind and inclusive can produce unintended medical risks — risks that school officials have neither the competence nor the authority to accept on students’ behalf.
Under this cover of compassion, we are creating a school-to-clinic pipeline. By “affirming” a child’s “gender identity” as fixed and real, adults can cement an otherwise temporary phase of confusion, distress, or innocent cross-gender play, transforming it into an “identity” and setting the child on a pathway to hormones and surgeries.
The medical literature supports this understanding of the school-to-clinic pipeline. Twelve studies to date have examined the rates of persistence and desistance of gender dysphoria from childhood into adolescence — a key indicator for whether gender-variant children should have their avowed gender “affirmed.” Eleven of them found that 61–98 percent of children come to terms with their sex if not socially transitioned, with most later coming out as gay or lesbian. The twelfth study, published earlier this year, is the lone exception. Nearly 98 percent of the study’s children persisted as transgender-identified, and most have either started or are expected to start hormones. What makes this one study unique? Unlike the majority of children in the previous studies, the children in this study were socially transitioned, evidencing the iatrogenic — said of psychological “treatments” which themselves cause mental infirmity — risk of social transition.
Critics of these earlier eleven studies argue that the children did not have a “gender identity disorder/GID” (the diagnosis name used at the time) but were merely gender-nonconforming, and that true transgender children do not desist. This claim is demonstrably false (another studyreanalyzed the numbers and confirmed that the majority of children who had the GID diagnosis did desist), and relies on the “No True Scotsman” fallacy. “The kids desisted? Well, they were never really dysphoric (or trans) to begin with!” There is, and probably never will be, a reliable way for clinicians to know who among the kids with gender dysphoria will have the condition throughout life (and thus be “trans”) and who will come to terms with their bodies.
The discrepancy between British and American approaches to childhood and adolescent gender dysphoria — the prevalence of which is skyrocketing — illustrates how out of step American medical organizations are with the evolving judgment of their counterparts in other, more LGBT-friendly countries. Sweden and Finland, for example, which once used the “gender-affirming” approach, have since conducted systematic reviews of the evidence (something no American medical organization has ever done) and have decided to dramatically scale backhormonal interventions.
Citizens and their doctors understandably want to follow the advice of professional associations like the American Academy of Pediatrics, but these groups do not always get the science right, and in the case of “gender-affirming care” there is ample evidence that they have let ideology trump science and common sense. For now, parents of American schoolchildren should simply know that when their school teaches gender-identity concepts (which, through the power of suggestion, implant confusion where none need exist), depicts transgender identity in a positive light, and encourages students to “question their assigned sex” as well as adopt new names and pronouns, it greatly increases the risk that their child will end up in a clinic and submit to irreversible procedures.