Public Discourse 21 October 2020
n increasing number of children, both here in America and around the globe, are experiencing deep discomfort, confusion, and alienation from their sexed body, a condition known as gender dysphoria. Unsurprisingly, people disagree about how best to respond to this condition in order to help these kids. How we navigate that disagreement will prove critical.
Some people insist that the proper course of action involves experimental interventions directed at the boy or girl’s body itself—puberty-blocking drugs, cross-sex hormones, and surgery. Others suggest that therapy be directed to the child’s thoughts and feelings, not the body.
Physical interventions on minors to “affirm” a mistaken “gender identity” violate sound medical ethics and should be prohibited. And yet, in all fifty states, such interventions are entirely legal.
At the same time, a more radical movement is seeking to make it illegal to use a psychological approach to help these children rather than a hormonal and surgical one. An increasing number of jurisdictions—both in the US and in other countries—are banning therapy that aims to help minors with gender dysphoria feel comfortable about their own bodies without transforming their bodies. Federal legislation has been introduced that would create nationwide censorship of such therapy, and the UN has claimed that such therapy violates human rights.
This turns medical ethics—and the law—upside down. Good therapy should never be prohibited. Children deserve access to the therapeutic assistance they need to feel comfortable being what they are as a plain and ineradicable matter of biological fact: male or female. And parents have a natural right to seek this care for their children.
What’s Wrong with Therapy Bans
Some argue that any attempt to help children feel comfortable and thrive as the sex they are, without transforming their bodies, is not good medicine, and they accuse practitioners of using abusive, harmful techniques. But they never provide credible evidence, and the therapy bans they support don’t target harmful practices. Instead, they prohibit working toward goals and outcomes that sexual progressive activists oppose. That is, these therapy bans aren’t focused on techniques that cause harm, but on certain objectives being sought—namely, being comfortable with one’s body.
As a result, one-on-one counseling to help a teen struggling with body image due to anorexia would be permitted, but the very same counseling would be prohibited if the goal is to help a teen struggling with body image due to gender dysphoria.
Activists use emotionally charged language, labelling all such techniques “conversion therapy.” They do not apply this label only to certain discredited techniques (such as electro-shock therapies), but to any therapeutic service—including basic talk therapy—to help a gender dysphoric youth feel comfortable without “transitioning.” Their argument is that if the true “gender identity” of the child is not being “affirmed,” then the child is being harmed. They claim that if a boy who “identifies” as a girl is helped to be comfortable with his actual and unalterable bodily sex, then “conversion therapy” is taking place—regardless of the counseling techniques deployed.
What can be said about this?
First, everyone should hope that minors experiencing gender dysphoria can find resolution without hormonal interventions or the amputations of perfectly healthy body parts. These are deeply invasive and often irreversible procedures that destroy functioning and alter visible physical structures. The best outcome is always for people to feel comfortable in their own skin and with their sexuality. So why ban that intended goal? Indeed, even if one thought that sometimes “transitioning” was the best outcome for a particular patient, is it really credible to say that it is always the best—indeed the only legally permissible—outcome to work towards?
Second, these sorts of counseling bans engage in misguided—and unconstitutional—viewpoint discrimination and content censorship. The government is taking explicit sides in what sorts of speech a therapist can engage in during talk therapy, and thus what sort of assistance a family can seek. If a family asks a therapist to support, encourage, and facilitate a child’s “transitioning,” the therapist is fine. But if a family wants to help a child with gender dysphoria feel comfortable with his or her own body, then a therapist risks violating the law if he provides the requested help. That’s unconstitutional viewpoint discrimination.
Furthermore, the law allows therapists to engage in speech to help a child feel comfortable with his or her body when they struggle with any other body-image problem. Only when that problems stems from gender dysphoria is helping a child feel comfortable with his or her body prohibited. That’s unconstitutional content-based speech regulation—in plain English, censorship. Thus, these bans engage in two forms of unconstitutional speech restrictions.
Third, there is no credible evidence to support such bans. The surge in gender dysphoria among minor children is a very recent phenomenon—tracking the rise of gender ideology. The United Kingdom, for example, has seen a 4,515 percent rise in gender dysphoria in girls over the past decade. Researchers have not had time to study the best therapeutic techniques for this modern form of gender dysphoria, let alone to say that the goal of helping a child feel comfortable with his or her bodily sex is always harmful and must be prohibited.
So, not only do these bans turn medicine upside down and engage in viewpoint and content censorship, but they also have no empirical justification. Even if there were evidence that a certain technique was misguided, that wouldn’t justify banning all techniques and thus preventing families from pursuing wholeness for a child.
Children Deserve Good Medicine
It is absurd to pass laws banning therapy aimed at wholeness when we lack laws protecting children from actual unethical and harmful procedures in this area. As a preliminary point, the best available empirical studies show no benefit of either hormonal or surgical transition. But whatever one may think about the ethics of medical professionals’ “transitioning” adults, everyone should be able to agree that adults should not interfere with the natural, healthy development of the bodies and minds of children, as Robert George and I have explained. Children must be provided with the time and space to develop to maturity.
To tell a child that he or she is the “wrong” sex – and is “actually” the opposite sex (or both sexes, or neither sex—something promoted today by standard children’s “gender” books), or to encourage a child’s mistaken belief that he is something other than a boy, or she is something other than a girl (however sensitively one may, and should, be handling such a situation), is deeply unjust to that child. To intervene in a child’s physical development, to block the child from going through normal puberty—all in an attempt to “affirm” a “gender identity” that rejects the child’s biological reality—is profoundly unethical.
Administering cross-sex hormones to minors, in an attempt to make their bodies cosmetically resemble those of the opposite sex or of their preferred “gender identity,” is likewise a violation of sound ethical norms and the bodily integrity of minors. Amputating reproductive organs or breasts to “affirm” a “gender identity”—as done to thirteen-year-old girls who underwent double-mastectomies in taxpayer-funded “research”—is particularly heinous. Governments should prohibit this misuse of medical technology and protect children from these harms.
By contrast, government should protect good medicine. The law must protect the freedom of parents to seek, children to receive, and doctors to practice good medicine. The law must protect the ability of doctors and families to help children feel comfortable as what they actually are, namely, male and female children—not to radically transform their bodies.