If kids consider transitioning, parents need to be involved
In the debate over transgender medicine, everyone seems to think they know better than parents. If you’re following the issue at all, you’re probably aware that several red states have moved to outlaw medical transition for minors, and that Texas went further still — went insane, I should say — sending child welfare authorities after families who supported a child’s transition. You might also be aware of extreme moves in the other direction. In September, California passed a law giving itself jurisdiction over custody disputes involving trans-identified youths who reside legally in other states. And as The Post and, more recently, the New York Times have reported, in many cases, some schools are supporting children who socially transition, by, for example, changing their names, their gender presentation or their pronouns, without telling their parents.
... Many liberal readers will be appalled to see the reactionary, transphobic Texas policy lumped in with California’s humane attempt to help vulnerable trans youths gain access to life-saving health care . ... My conservative readers, meanwhile, are mentally shouting that Texas is trying to keep confused teenagers safe from a medicalindustrial complex gone mad, while California is encouraging them to harm themselves with dangerous interventions for which there is no clear evidence . ...
Most people on both sides are undoubtedly sincere in their desire to do the best for trans-identified youth — and probably firm in their conviction they know what that best thing is. Which is the central problem of this debate: Everyone seems far more confident than they should be, given how weak the available research is.
The studies of puberty blockers and cross-sex hormones have generally been small and uncontrolled and often have significant dropout rates. Research tends to cover short periods, when what we really want to know is how the patients will feel decades hence about treatments that can have lasting social and medical consequences and some potentially serious side effects. And a lot has changed over the years in the assessment and treatment of gender dysphoric youth, making it tricky to extrapolate to today’s kids what little longer-term data we have . ...
Which is why, until we know for sure, we need to leave these decisions to parents.
I recognize that schools have often opted for secrecy out of fear that parents will torment a child who comes out to them as trans, or possibly even kick them out of the house. This does happen to too many trans youths. But that’s a good reason to have clear protocols for dealing with cases of child abuse, which is what we’re describing, not a reason to treat all parents as potential abusers who cannot be trusted with the news of a child’s gender dysphoria.
Similarly, I recognize that red-state politicians sincerely believe that affirming gender dysphoric children socially or medically means putting them on a pathway that can lead to hormones, possibly to surgery and, either way, perhaps a lifetime of strenuous medical intervention. But the Texas policy of siccing child protective services on loving parents is undoubtedly causing more harm than it could possibly avert.
Of course, parents are not all medical researchers who can parse complicated literature. Nor can they fully understand what it is like to be trans. But then, neither can adult trans activists, who have often been the default voices on this question, know what it’s like to be a kid whose gender dysphoria eventually goes away, as historically seems to have happened with a significant fraction of such children. “A child is not a small adult,” as Riittakerttu Kaltiala, one of the Finnish researchers studying this topic, recently told the Helsingin Sanomat newspaper; their emerging identities may not be as stable, or their grasp of the consequences as firm, as trans adults who are, of course, fully capable of making their own decisions.
What we do know is that most parents passionately want their kids to have a good life. They care more about that than anything else, and certainly more than any other adult does. At the same time, they understand, as the children cannot, the magnitude of the consequences they might face — what it means to lose a loved one to suicide, but also what a child who takes puberty blockers or hormones might be giving up, if for example they end up unable to have their own biological children.
These are hard questions that often force difficult trade-offs, and I’m sure parents will not always get the answer right. But I’m also sure they’ll give it their best shot. And until we have better evidence, that’s the best anyone can do.