Ban Politics from Gender Healthcare

The Right and the Left Are Competing for Who’s Worse

Today’s guest post by gender correspondent Lisa Selin Davis, like all of her posts, is an appeal to reason and moderation on a subject that tends not to admit of either. It is addressed toward fellow lifelong progressives like herself who have been, as she once was, intimidated into silence by the ferocity of the policing of correct opinion on this subject before mustering the courage to investigate herself. She implores them to exercise their independent judgment — to observe and to think — when both activities tend to come with enormous risks and penalties.

It therefore leads by pointing out the aspects of conservative backlash against the trans movement that discomfit her, and goes on to discuss the enormous peril posed by a recent Biden Administration executive order that would effectively prohibit the open-ended exploration of the various psychological distresses that may turn out to be at the root of gender dysphoria — reclassifying it as “conversion therapy” — in favor of federally mandated affirmation of a trans identity.

This sort of question-begging approach goes far beyond the recent standards of care adopted by the international guild of gender clinicians ; it is a mark of genuine extremism that the Democratic Party and its President have fully embraced. We have to pull back from this brink.

By Lisa Selin Davis

One reason Democrats object to Republicans’ attempts to ban “gender-affirming care”—puberty blockers, cross-sex hormones and surgeries for minors—is that they’re too heavy handed. The bans wrest decisions from doctors, patients and parents and place them in the hands of government. It’s overreach: one-size-fits-none.

But no party is above hypocrisy, especially when it comes to medical authoritarianism. On Wednesday, the White House issued an “Executive Order Advancing Equality for LGBTQI+ Individuals” that’s dangerously overreaching, too.

How, you might be asking, can the promise to do things like address discriminatory legislative attacks, ban “conversion therapy,” and safeguard “health care, and programs designed to prevent youth suicide” for LGBTQI+ kids be conceived as harmful? Such aims sound good on paper, and some are. The announcement asserts that “no one should face discrimination because of who they are or whom they love,” and amen to that. (By the way, the Bostock decision essentially forbids such discrimination.)

But it’s hard to wake up the Left to the complexity of what it means for a kid to identify as trans, and what kind of care such a kid needs, when their arguments are wrapped in the shiny veneer of social justice language that we’ve been conditioned to genuflect before. Who else would object to a ban on conversion therapy or programs designed to prevent suicide but a hateful bigot?

Well, an entire silenced and ignored swath of the Left, which understands this issue in a much more complicated way—especially when it comes to conversion therapy.

Biden’s order describes conversion as “a discredited and dangerous practice that seeks to suppress or change the sexual orientation or gender identity of LGBTQI+ people,” and asserts that children exposed to it “face higher rates of attempted suicide and trauma,” though with no citations and no further explanation of what conversion therapy entails. It’s fair to concede that conversion therapy for sexuality is a losing battle, and trying to pray or shame the gay away has been both unsuccessful and deeply unsettling for those who’ve been through it.

There’s not much research on conversion therapy for gender identity, however, and what little there is very low quality. A 2019 paper, “Association Between Recalled Exposure to Gender Identity Conversion Efforts and Psychological Distress and Suicide Attempts Among Transgender Adults,” published in JAMA Psychiatry, asserts that “lifetime and childhood exposure to gender identity conversion efforts are associated with adverse mental health outcomes.” But when you read carefully, you see that the methodology is so weak, the sample so skewed, that it can’t be applied to the general population.

Nonetheless, the American Academy of Pediatrics’ policy states that “any therapeutic intervention with the goal of changing a youth’s gender expression or identity is inappropriate.” It continues, “Reparative approaches have been proven to be not only unsuccessful but also deleterious and are considered outside the mainstream of traditional medical practice.” Yet as Manhattan Institute fellow Leor Sapir wrote, “when the American Academy of Pediatrics denounced non-affirming approaches as ‘conversion therapy’ in 2018, it based that conclusion entirely on studies done on homosexuality and omitted all relevant studies on youth gender dysphoria.”

We can’t assume gender identity operates the same way as sexuality, especially when the majority of children with gender dysphoria—those who weren’t socially transitioned, anyway—once grew out of it by the end of puberty and didn’t grow up to be adult transsexuals. In fact, the majority were gay, raising the specter of an association between gender dysphoria and same-sex attraction.

Accepting yourself as gay requires nothing more than a shift in perspective. But accepting yourself as trans may mean rejecting the name your parents bestowed upon you, the meaning of language, and biological reality, along with drastic medical interventions. Will they make some kids feel better? Research suggests so, at least in the short term. But since we have no studies comparing different modes of treatment we can’t know for sure.

That’s why some gay adults who had gender dysphoria as children think of the affirmative model and social transition, associated with persistence of a trans identity, as a kind of conversion therapy itself. I’ve talked to many gay adults who were gender nonconforming and gender dysphoric as kids who would have leapt at the chance to socially and medically transition—and are so glad they didn’t. Meanwhile, a detransitioned man, Tullip, detailed on Twitter the horrors of his surgery, and why he underwent such a drastic medical intervention: He could not accept himself as gay. If only he’d had some exploratory therapy, rather than been affirmed, he could have spared himself invasive interventions with lifelong negative consequences that he now regrets. He was an adult when he transitioned.

This isn’t to say that gender nonconformity itself hasn’t been misunderstood by the field of psychology. Dr. George Rekers’ “sissy boy” experiments used Pavlovian methods to reprogram feminine boys and masculine girls so they’d perform their proper gender roles—those who fear conversion therapy bans don’t want to return to the days when feminine boys were actively dissuaded from their behaviors and inclinations (as opposed to identities) because “Boys would find his feminine interests unappealing. Girls would want more boyish boys,” as an NPR article from 2008 notes.

Was it bad to try to twist a child out of their natural masculinity or femininity because of parental discomfort, or because there was no room for such children in our culture? Yes. Conversion therapy is bad because children feel rejected by their parents and society and that can have lasting negative effects. But I think we’re starting to see that the affirmative model is having lasting negative effects, too, not just on children but on their families and on society. Let children be as masculine or feminine as they are or want to be, and stop making meaning out of it. 

We could all agree that we needed to protect trans kids if indeed there was a way to determine just what kids are trans and know that their dysphoria would persist without medical interventions. But the only way to find out who will persistently identify as transgender or want to grow up to take a pathway call transition is through comprehensive evaluation that does not assume the answer in advance of consideration of all relevant factors — exactly the sort of investigation that the Biden Administration’s ban on conversion therapy would in practice rule out.

Even the World Professional Association of Transgender Health (WPATH)—an advocacy organization that sets the Standards of Care from which its members profit—suggests that mental health providers “assess and treat any co-existing mental health concerns of children or adolescents,” and “educate clients and their families about therapeutic options.”

Yet a conversion therapy ban may mean that therapists must affirm, rather than investigate with the child what might be causing distress. It essentially prevents therapists from doing therapy, and there are plenty of people who transitioned without it out there ringing alarm bells whilst Democrats plug their ears.

For instance, detransitioned woman Sinead Watson wrote a thread about her experience of gender affirmation without exploratory therapy. Her history of depression, self-harm and suicide attempts was ignored by her gender doctors. So were her four mental breakdowns, “including a psychiatric hospital stay due to dissociation.” She had no gender dysphoria during childhood, she said, and no thought of transition until her 20s. All those things were ignored—but her identity and desire to medically transition were affirmed.

Many of the young people I’ve talked to really did believe that they could change sex. One woman I interviewed this week said that her son got hormones at Planned Parenthood just after turning 18, and told her he couldn’t wait to get his period. He’d been in and out of psychiatric facilities for months, but Planned Parenthood didn’t provide any mental health evaluation. That’s not part of the informed consent model.

The affirmative model Biden promotes assumes that a child is trans if he, she or they say they are, rather than seeing a child as having a condition called gender dysphoria and asking how best to treat it. Should all kids be affirmed, offered a new identity and cross-sex hormones and genital and chest surgeries to go with it, based on their subjective reports, without comprehensive evaluation?

My guess is a lot of people would answer no to that question if it were put that way instead of “should we ban conversion therapy?” Few of us allow our teens to make life-altering decisions, or administer medicine or surgery based on their own diagnoses There is almost no other aspect of childhood, or of medicine, which operates this way.

Biden’s order arrived on the same day as a New York Times Magazine article dropped, one which pokes [not-nearly-big-enough] holes in the narrative that the gender-affirming model, in which children are socially and medically transitioned based on their own self-diagnosis, is the best treatment method for gender dysphoric youth. And it arrives just after the country’s first nonpartisan evidence review, which concluded that these the evidence of these treatments’ efficaciousness was of such low quality that they couldn’t be deemed medically necessary. That should have been the biggest news about this subject we’ve had in months, but there was nary a peep from the media.

Meanwhile, while countries like Sweden and Finland are pulling back on these interventions altogether, WPATH is lowering the recommended age for hormones and surgeries. Why is the U.S. straying so far from the caution other countries urge? Why is Biden digging in instead of taking a step back?

Perhaps he’s matching the Republicans fervor. It's not ideal to ban hormones and surgeries for kids, either—we don’t want the state or federal government making those kinds of decisions (see: abortion). Rather, we need new guidelines and standards of care that reflect the reality of a growing and increasingly complex cohort of children; acknowledge the past relationship between dysphoria and sexuality; and ensure that therapists properly investigate the sources of gender dysphoria.

Finally, if you think the Republicans are cruel, note that Biden has threatened to withhold the funds for poor students’ free lunches if a school has non-affirming policies. He’s also threatened to withhold funding for any programs offering conversion therapy—what if those programs offer other kinds of important treatment? The left and the right are equally mad. But the right’s ban prevents kids from accessing meds and surgeries for a couple of years, making it harder for them to “pass.” The left’s will starve kids if an institution doesn’t adopt ideologically-driven policy. It’s hard to know which side is more ideologically captured, and which cares less about these kids.

Much of the left, or at least our politicians, seem to assume that these Republicans’ use of language like “safeguarding children” obscures their true diabolical motive: “harmful, hateful, and discriminatory attacks. Personally, I think these bans directly respond to the cries of the thousands of parents — many or even most of them Left-leaning, for it is progressive schools that generate the strongest peer influence — who feel strong-armed into affirming their children at the expense of their mental health. Sure, they score political points with the base, but that “Don’t Say Gay” bill turned out to be popular with Democrats, too. Biden remains unwilling to see this.

Until we stop teaching children that sex and sex stereotypes are the same thing, that puberty is an aesthetic choice and sex is truly changeable, we shouldn’t ban the only option they have to help them find their way through gender dysphoria. The greatest shame is that helping a child to be comfortable in his or her body is considered conversion therapy. Most of us struggle our whole lives to love our bodies, and we could all use help.