Recent pushback on “affirmative care” and hormone blockers

July 31, 2022 • 9:15 am

I’m guessing that some day historians will look back at the mishigass surrounding “affirmative care” and wonder what the deuce was going on in America in the 2020s.

Now let me say at the outset that I have no objection to people with “gender dysphoria” changing their gender using drugs and surgery. But I also think that transitioning should not be allowed until after puberty, and for two reasons. First, we don’t know eough about the safety of “puberty blockers” used to stop the process while adolescents figure out their sexual identity, and second, because children who are too young to make mature judgments should not be allowed to make irreversible decisions about their bodies. Eighteen seems to me to be an appropriate age to begin a medical process of transitioning.

My objection to “affirmative care” is not that we shouldn’t treat young people repectfully when they have with a sincere desire to transition, or fail to support them. But in the U.S., and previously in the UK, the default option was “affirmative care”, with no real psychological probing to dissect the roots of gender dysphoria and see if it was a form of distress that might resolve into a child becoming gay. “Affirmative care”, in its most extreme form, pronounces children who question their sexuality as transsexuals, deems them ready to change sex, and encourages them to go on puberty blockers and then hormone therapy. (There are few adolescents who, once on blockers, decide to stop them and “de-transition.”)

I’m cautious because the huge rise in the number of adolescents who declare themselves transsexual (particularly biological women who want to change gender) could have a number of causes: a relaxation of the stigma against transsexuality, an increase in the genetic propensity to change gender (that’s impossible given the rate of the rise), or—as Abigail Shrier argues in her book Irreversible Damage, a sort of social contagion—a sense among young people that it’s far more cool to be trans than to be gay, and because such people get a lot of props and attention. (Shrier doesn’t claim that transition is always prompted by social contagion.)

Only the first and second hypotheses are supportable, and I think both are at play, but to deny that social contagion hypothesis plays any role in the temporal changes shown below is to deny reality. There are simply too many cases of seeing “detransitioners” (“desisters”) discuss the social pressure they were under, and of others seeing it at play in real life.

Below is an article by writer Lisa Davis you should read (click the screenshot). It’s on Bari Weiss’s site (and I don’t want to hear that Weiss is “alt-right” so that you can ignore it), and explains how several European countries, including the UK, Sweden, France, and Finland, are changing course on affirmative care, replacing it not with a refusal to let people transition, but with a more compassionate and psychologically-oriented inquiry into the roots of gender dysphoria.

The change in Europe comes from a realization of the weakness of the evidence supporting two assertions of trans activists: that puberty blockers are completely harmless and can be completely reversed if someone changes their mind, and that allowing medical transitioning reduces the rate of mental illness and suicide among those with gender dysphoria. We now know that the evidence for the first claim is wrong, and for the second is plagued by methodological weaknesses. We simply need a lot more data, and the Europeans are being cautious while Americans ignore the counterevidence. That’s unwise given the drastic and irreversible nature of many transitions.

Here’s a graph from the article above showing the increase in referrals to the gender-affirming Tavistock clinic, and this is just between 2009 and 2017 (original source here). Both the proportion of and the increase in biological females (compared to males) referred to the clinic for affirmation have increased substantially. If your hypothesis is that the rise reflects purely the de-stigmatizing of transsexuality, this discrepancy between the sexes must be explained. Of course, it also has to be explained if you hold a “social contagion” hypothesis.


I completely agree with Andrew Sullivan in his Friday column section called “Yes, the trans madness is real” when he says this:

I recall a few years ago having a heated conversation with some well-meaning trans activists who appeared completely aghast when I voiced some worries about the treatment of kids with gender dysphoria. What if the kid is gay, I asked? How do we know for sure if a pre-pubescent child really is trans and not just experimenting with gender the way many gay kids do? And are these nine-year-old children really mature enough to make life-long decisions that could make them permanently sterile, keep them on drugs for the rest of their lives, or permanently remove their capacity to have an orgasm? How could pre-pubescent kids even know what an orgasm was?

My activist friends were shocked. It seemed to me as if they had never previously been asked these questions. They were all very-well intentioned, and not entirely wrong — in a few extreme cases, there might be a reason to permanently change a child’s sex. But they assured me that no such errors were ever made, that the process was entirely ethical, and that all medical authorities backed it. They insisted that puberty blockers were harmless and fully reversible. The bubble is real.

I think it’s better to give kids with gender dysphoria extensive psychological counseling—NOT affirmative from the outset, i.e., not “affirming” that children who say they’re of another gender must be right—before giving them irreversible medical treatment, treatment that we now know can render people sterile, unable to enjoy sex, and, in the case of puberty blockers, cause other medical damage. Sullivan, who experienced dysphoria himself, says that many adolescents go through a period of confused sexuality, and perhaps would become gay were it not more fashionable to change gender.

Both articles detail some big changes in Europe about how to treat gender dysphoria. I’ll summarize what most of us know already (the first article above gives links):

  • Sweden has revised its guidelines for treating gender dysphoria in adolescents, arguing that gender-affirming treatment may be more harmful than good, and claiming that affirmative treatment “should be offered only in exceptional cases.”
  • Finland, using an evidence-based approach showing that many young people seeking transitioning had severe psychiatric problems, that there were risks to using puberty blockers (see below), both physically in in terms of sexuality, changed its protocol for treating gender dysphoria:

(From Davis’s piece): In Finland, for patients who fit the profile of participants in the Dutch study, after a prolonged period of evaluation, and with a multidisciplinary team including a psychiatrist, psychologist, social worker and nurse, puberty blockers may be started near the onset of puberty, and cross-sex hormones may be possible starting at age 16. Assessments take place at two gender identity clinics; gender surgeries are offered only at one center. Both Finland and Sweden now stress gathering data and extensive follow-up.

My own view is that giving puberty blockers “near the onset of puberty”, or at age 16, is too young.

  • The National Academy of Medicine in France has urged caution in proceeding with drugs and surgery in cases of gender dysphoria since some of it may be due to social contagion. It recommends more extensive psychological counseling of those with gender dysphoria.
  • The Tavistock clinic in London (a notorious place for affirmative therapy) is to be closed, replaced by a number of regional clinics practicing a different brand of care. This is the result of a critical review headed by Dr. Hillary Cass, commissioned to review Tavistock and its practices. Their recommendations, which the government accepted, was to de-centralize the clinics, adopt more “holistic care”, and ratchet back on the use of puberty blockers, which now appear to have possibly severe medical consequences.
  • The medical consequences of puberty-blocking drugs like Lupron, which according to Sullivan have been known for a while, include brain swelling and loss of vision, possible bone damage, and other irreversible effects. In fact, these blockers are used for other conditions, and I understand are always prescribed by doctors treating gender dysphoria “off label”, i.e., they’re not specifically recommended by the FDA for stalling puberty while a child ponders its gender.

This month the FDA added brain swelling to the warning labels of puberty blockers. The sample size is small, and these problems appear only in biological females (the most common sex experiencing gender dysphoria), but an FDA warning is nothing to take lightly. Here’s a tweet about the dichotomy between the American use of blockers willy-nilly in American “affirmative care”, and the warnings on drug labels. Clearly, more research needs to be done (that’s what Sweden and Finland concluded) before blockers are used so readily. But, in contrast to the caution about other new remedies, like Covid-19 vaccines, the standards for usage are very lax in the U.S., and were in the UK as well:

Nevertheless, as both Sullivan and Davis point out, the U.S., urged on by the Biden Administration, is going full steam ahead with affirmative care.


In the US, however, as many states move in the European direction, the left is pushing harder. California has a bill offering sanctuary for any child seeking a sex change. The Biden administration still insists that “every major medical association agrees: gender-affirming care is life-saving, medically necessary, age-appropriate and a critical tool for health care providers.” The absolute certainty, compared with the second thoughts in Europe, is striking.

Davis, referring to Finland and Sweden’s revised guidelines in comparison to America’s (my emphasis):

Both guidelines starkly contrast with those proffered by the Illinois-based World Professional Association of Transgender Health, an advocacy group made up of activists, academics, lawyers, and healthcare providers, which has set the standard when it comes to transgender care in the United States. WPATH will soon issue new standards that lower recommended ages for blockers, hormones and surgeries. (WPATH did not respond to a request for comment.)

WPATH’s position is in keeping with an array of U.S. medical associations and activist groups across the country that insist gender-affirming care is “life-saving.” Assistant Secretary of Health Rachel Levine, who is herself a transgender woman, recently asserted that there is a medical consensus as to its benefits. Some activists and gender clinicians in the U.S. feel that WPATH doesn’t go far enough, asserting that any child who wants puberty blockers should get them, for instance, or claiming that a teenager who later regrets having her breasts removed can just get new ones.

In Sweden and Finland, this issue has been primarily a question of health and medicine. Here in the U.S. it is a political football.

Why the ignoring of evidence and lack of caution in the U.S. as opposed to Europe? Why are we not following the examples of countries that take an evidence-based approach to medical policy about gender dysphoria? Surely one of the reasons is “wokeness”: the idea that changing gender is to be admired as an act of courage, and that transgender people, or those who wish to become so, should be valorized as members of stigmatized minorities. And, sadly, the Biden administration has bought into the pronouncements of the extreme Left, which include unquestioning approbation for “affirmative care.”

Yes, there’s some stigma about transgender people, and yes, we should help those who, after intensive medical and psychological examination, are deemed to be serious about their gender misindentification rather than confused about their sexuality. And yes, we should treat transgender people in nearly all respects as equals to members of the biological sex they assume.  But what we should not do is, in the interests of seeming virtuous, rush children and adolescents into very serious and irreversible medical procedures without proper vetting.

39 thoughts on “Recent pushback on “affirmative care” and hormone blockers

  1. Couple of typos:
    -Paragraph 3: I think “My objection to “affirmative care” is not that we shouldn’t treat young people disrepectfully” should be “respectfully.”
    -Paragraph 4: I think “I’m cautioous because” should be “cautious.”

  2. Another possible cause for the rise in transgender identities for both children & adults is that they’re a readily available explanation for feeling as if you don’t fit, don’t belong, or don’t feel right. It’s not so much a desire to feel “cool” as a desire to escape distress. Culturally-bound syndromes are created narratives which provide both a framework for understanding what’s wrong and a method of fixing it. The human universal is gender nonconformity, or trauma related to one’s sex. But how it manifests itself depends on the time and place people are born in.

    Here’s an interesting essay on the topic:

    No one is pretending. Our cultural expectations shape our reality. Both those things can be true.

    That’s an important point I think — that the vast majority of people who identify as transgender aren’t lying, exaggerating, or just seeking attention. Their suffering is real — and the explanation feels natural and organic, as if it were a self-generated self-realization with a personal history. “I’ve always known this, I’ve always known I was really the other sex. It makes total sense.”

    But the trans story — that it’s a human universal, that people are “born this way,” that it’s just like being gay, that we all have a Gender Identity that must match the way we’re treated, and that therefore the only remedy is to transition — isn’t true. And accepting children’s insistence that it’s their Real Self by affirming and allowing them access to hormones and surgery is grossly irresponsible.

    1. The counterpart to that argument has to do with the parents.

      To compensate for the plethora of psychological matters that do not go away in childhood and parenthood, the impulse to medicate the problems away – be it hormone blockers or psychotropic drugs – is strong. Matters are not helped when incentives are set up to promote the impulses.

      Titles on these matters :
      Girls on the Edge, Boys Adrift, Why Gender Matters, The Collapse of Parenting
      Leonard P. Sax

    1. I meant to add that “CAMHS” referred to in the article stands for Child and Adolescence Mental Health Services.

      Transgender Trend is a great source of balanced analysis and the website is well worth exploring.

  3. Sonia Sodha, writing in today’s The Observer, also has a good article discussing some recent developments in the UK on issues around gender identity:

    (The Observer shares an owner and website with The Guardian, and so often thought of as being “The Guardian on Sunday” , but it is editorially independent and has been much less captured by Woke ideology than its sister paper.)

  4. Blaire White and Buck Angel on YT

    I sit down with trans man (and icon) Buck Angel to discuss our thought on transgender children, detransitioners, puberty blockers, hrt, and the state of trans politics.

  5. If, as I do, you view the trans pandemic — especially the late and rapid onset eruption, often in copycat clusters of teen girls — as a project driven by neo-Marxism to destroy capitalism, the persistent roar of it in the United States appears logical. Sweden and Finland are not exactly “the front.”

    This conspiracy theory* does not require denial of actual gender pain. It emerges as a resetting of Rahm Emanuel’s quote: never let a meme-able real hurt go un-exploited; launch it viral as a cancer intrinsic to capitalism/patriarchy. Marxists have had their hearts set on disrupting — and teeth barred to gnaw on — the disruption of Genus Homo’s binary and stable sexual identity for generations.

    *just because a bizarre event (rapid onset of clusters of teen girls with no prior dysphoria suddenly insisting they are boys) is woven by PersonA into a conspiracy, and thereafter mocked by PersonB as a “wing nut conspiracy theory” does not make PersonA wrong.

    1. I find it difficult to believe the ideology is primarily driven by a desire to destroy capitalism when so many corporations are enthusiastically on board with Trans Pride, with promoting Diversity Equity & Inclusion, and with manufacturing and selling all the resulting paraphernalia, including hormones-for-life. I wouldn’t say it’s a money-making conspiracy either, though. It’s probably caused by a variety of factors.

      Conspiracies are satisfying and simple; real life tends to be unsatisfying and messy.

      1. why did you not agree with me, as such: ‘the conspiracy is working from evidence of intrusion into corporate America of WokeMarxist graduates of our universities. Those younger people are carrying out the assignment.’

        additionally, sometimes ‘messy’ is only the deliberately spurted fog of war.

        1. Maybe I’m not sure what you’re saying. The capitalist heads of corporations are believers … who have been convinced by capitalist youth who are believers … who have been convinced by anti-capitalist academics who don’t actually believe but have an agenda to destroy capitalism?

          It seems to me that the motivations for most Genderists are more likely
          1) get rid of sexism (via Underpants Gnome methods)
          2) not commit a mistake similar to homophobia or racism
          3) protect the vulnerable
          4.) promote autonomy & self-actualization
          5) be on the right side of history

          Capitalism looks more to me like it’s being used as a tool and/or is using transgender as a marketing strategy. Though you’re probably right about a neo-Marxist element in the mix.

    2. … Rahm Emanuel’s quote: never let a meme-able real hurt go un-exploited …

      That’s not a quote; hell, it barely qualifies as an extremely loose paraphrase.

      By your lights, does Rahm Emanuel count as a neo-Marxist?

      1. For correction to your disdain, suggest you reread my post with full radar on the lookout for the word “resetting.”

        1. If that was your meaning, you employed some sloppy syntax and awkward usage in the effort to achieve it.

  6. One notices that “affirmative care” includes the same soothing adjective as “affirmative action”. In retrospect, it is surprising that the decriminalization of trespass, vandalism, and petty theft for which
    Chesa Boudin recently lost his job in SF wasn’t labelled “affirmative criminology”. No doubt the exclusion of professionals for inadequate Diversity Statements, soon to come in academia, will be
    labelled “affirmative exclusion”.

  7. I think that what we’ve been seeing in the last decade or so is the Tumblr/Instagram generation of girls dealing with something that has existed forever, but we don’t talk enough about: a large percentage of women are not okay with being sexual beings, they’re not even close as interested in sex as men are, and find the vast majority of men sexually unattractive (Tinder statistics suggest 95%). I don’t believe they’re trans (except for a few), but they are trying to create a new space in society for them, a space for women not interested in men.

    1. a large percentage of women are not okay with being sexual beings,

      Care to expand on this? I am having trouble imagining this to be true.

      1. I should’ve said, “a large percentage of women have zero, or little interest in sex”. You can infer this from statistics about self-gratification, for instance. That is the opposite case of male homosexuality, where sexual desire is at the core. We have recently created a space in society for gays (and lesbians), but not yet for this much larger population.

        1. I think you may be underestimating the effect easily-accessible and sometimes violent pornography has on teenagers and even children of both sexes. This is pretty recent.

  8. “Affirmative Care” strikes me as similar to so-called Conversion (aka Reparative, aka “Pray Away the Gay”) therapy — both worse in its way (in that it can result in irreversible physical changes) and better in its way (in that at least kids aren’t being forced into against their will). I note that Conversion Therapy (the efficacy of which is unsupported by any empirical data) has been banned in many jurisdictions.

    1. Funny you should bring that up, the alternative to affirming care that our not-at-all-transphobic host is referring to above is for all intents and purposes conversion therapy. It was developed by the same person and has the same goal of persuading the patient that they are incorrect about their identity.

      1. Youhave no idea what you’re talking about. The alternatives to affirmative therapy recommended in Europe were developed by different people. And of course I don’t think the therapy should be directed one way or another; that’s clear. One needs an empathic therapist to talk through the alternatives with a patient.

        But I knew some idiot would come over here and call me a transphobe for criticizing affirmative therapy. I guess you’re of the “Believe ’em, inject ’em, and cut ’em” school.

    2. The old “conversion therapy” tried to change the mind of gay men to fit their male bodies… re-direct the gay male mind from other men to women.

      The new “conversion therapy” changes the body to fit the mind.

      1. Yes, I understand that; they are, in their way, the obverse of one another. Yet both present similar (albeit distinguishable) harms.

    3. I think Izzy ignores an important difference between “pray away the gay” and “affirmative care”. The former is a misguided effort to change how a person objectively views many other people (and finds some of them sexually attractive). This is comparative. The latter is a misguided solution to a subjective view of one person (himself). This is solipsistic, especially in transwomen with autogynephilia.

      From both those points of view, it’s obvious that people with same-sex attraction and people with gender dysphoria shouldn’t be encouraged (or harassed) into either a psychiatric or medical change. They should just be left alone. Nobody should be forced by psychiatry or surgery to conform to some narrow sexual stereotype of how a man or a woman is supposed to look and act and dress and talk.

      The other big difference is that there is no such thing as a soul-like gender identity that is innate, knowable by self-inspection, and fixed, but also fluid and socially constructed. There is just sex (binary) and personality (almost infinitely variable). So from that pov psychiatric care for gender dysphoria seems likely to do more good than harm, since the dysphoric person really is experiencing a delusion. Some dysphoric people won’t want to be treated for that delusion, but that doesn’t mean everyone else has to agree that the delusion is real.

      1. Absolutely. The abusive elements of conversion therapy are already illegal in the UK, but it is important that people presenting as gender dysphoric are properly assessed and diagnosed, and any underlying conditions treated.

        There is no other scenario in which a patient rocks up with a self-diagnosed condition and sets out the treatment plan they want and then expect that to be provided unquestioningly.

        Imagine if someone with anorexia told a doctor “I’m disgustingly fat and want weight-loss medicine and liposuction” and the doctor felt compelled to affirm the patient’s feelings. It doesn’t bear thinking about.

  9. Here’s what I am struggling with. This dysphoria has a set of causes or even there may be sets of causes. This has to be true if we accept a causal world. Now if we identify the causal basis of the dysphoria does it make sense to eliminate the cause(s)? The causes might be genetic in origin, hormonal, environmental or even societal (part of environmental, I know); most likely a combination.

    1. @Rom

      I remain cautious of this approach. I recall that in the 1990s in the USA, there seemed to be a frantic search for “the gay gene” that would prove once and for all to homophobes (and everyone else) that we LGBs are “born this way,” thus any social, political, economic, and especially religious discrimination is unjustified and nothing more than pure bigotry. We can’t help it; it’s genetic. We’re safe; it’s not a choice, as we’ve been saying all along. What a relief, right?

      The reverse, however, is also true: if “the gay gene” is the cause, then it can be repaired (now with CRISPR.) LGBs can be permanently fixed or cured! We may be born this way, but now we don’t have to act this way. Biology is not destiny!

      But do LGBs want to be cured? I don’t. I’m sure there are some who will. Who says that LGBs need to be cured? I think most of us are fine the way we are; homophobes are the problem, not us. We just want to live our lives in peace.

      So I see a slippery slope with finding a biological cause of transgenderism. If a cause exists, then theoretically it can be repaired. As you say, likely it’s multicausal. But do trans people want or need to be cured? And what of trans-identified people who lack “the trans gene?” They must be deluded and receive psychiatric care, right?

      I think society needs to rationally and soberly evaluate medical care of trans-identified people and all its implications. I’m glad to see that the fascist dictatorships in Scandinavia and France are leading the way.

  10. I also wanted to add that, before I was banned from Twitter for “hate speech,” I read a long, heartbreaking thread from a woman who was subjected to “affirming care.”

    Paraphrased, the tweeter said that at puberty, she received much more unwanted male attention – everything from sexual innuendoes to harassment to assault. She said that a lot of men kept grabbing her breasts. She didn’t want men to do this, and she became anxious and depressed. Her mom brought her to a therapist.

    The therapist told them both that if the tweeter didn’t enjoy having her breasts touched, she must really be a boy and not want to have breasts. **So the woman’s body became the problem, not the male behavior.** The therapist convinced the tweeter and her mom that she should transition. She was 14.

    Neither the tweeter nor her mom knew anything about transgenderism or gender ideology at the time. They were just average people looking for help. They trusted the therapist.

    After the usual drugs, the tweeter had a double mastectomy at 14. Sure enough, the unwanted male attention stopped. At 16, the tweeter stopped the drugs and “desisted.” She posted to trans groups about her experience about losing her breasts, and they told her that she could just get prostheses, no big deal. The tweeter argued with them, and they kicked her out. She said all the trans groups kicked her out.

    Now 24, the tweeter said that she sobs every day. She will never experience sexual pleasure from her breasts, she will never breastfeed, and she lost healthy parts of her body and herself. She said that she reported the sexual assaults to her school, but they did nothing. She tweeted that her therapist lied about transitioning and should have helped her with her sexual harassment complaints against the school. Instead, **her body was the problem, not the male behavior.** She tweeted that she no longer trusts therapists.

    I just can’t stop thinking about this poor woman and the doubtless thousands like her, victims of trans extremism.

  11. I see a pattern here of assuming that gayness is a major factor in the trans movement. The argument seems logical, that a child noting an attraction to persons of the same sex might be easily convinced that they were born in the wrong body.
    That conflicts with my experience that many or most trans kids only become gay once they start identifying as the opposite sex. So a child born a boy transitions to a lesbian girl.

    The puzzle to me is not about the kids. Kids can be convinced of almost anything, especially by an adult in a position of authority or trust. The thing I am trying to work through is exactly what is motivating so many adults to focus so much of their energy on convincing healthy kids to adopt this ideology.

    My view is that children of a vulnerable age are being taken advantage of by adults who either have malicious intent or are themselves terribly deluded, as the people who facilitated the recovery of memories of satanic abuse likely were decades ago.

    I suppose some percentage of those facilitating this process are actually committed Marxists who want to disrupt gender and sexual norms for ideological reasons. However, when such a movement took root in the DDR, it appears that many of the most enthusiastic adults involved were actually motivated more by the fact that endorsing the philosophy allowed them to have lots of sex with children. The current movement in the US certainly allows teachers and school counselors to talk to little kids about sex in a very graphic manner. It is hard to find objective data, but from what I have been able to find, the scale of the problem of school staff actually committing sex crimes against children is at least on par with the accusations against members of clergy.

    I would certainly find it more plausible that the bulk of the groomers* are working from misguided good intentions rather than to accept the view that school counselors and teachers actually want to push their students toward a life of early sexualization, and leading almost certainly in depression and self-harm.

    *I use the word carefully, without political intent. A pederast would generally start by working to get the target child comfortable thinking and talking about graphic sexual activity. No responsible parent is going to accept “It is fine, I am a teacher” as an excuse when you overhear your second grader talking about anal sex, and you confront the adult who keeps telling them about such things.

  12. Too often “affirmative care” is substituting “Cut away the Gay” for “Pray away the Gay”. I’m not convinced that the former is better than the latter. Both are done under the idea that the conversion therapy proposed will improve the life of the patient. In neither case is there strong evidence that this is always or even often the case.

  13. Interesting how talk of “57 genders” disappears, and we’re back to choosing between just male / female.

  14. When “Rough Times—formerly the Radical Therapist” was published by a small clique in 1972, it
    announced its positions as follows: “support for worldwide socialist revolution; belief in the exploitation of labor as today’s primary cause of people’s oppression; support for all just liberation struggles; deep involvement in and support for the mental health/self-help struggle; belief that the psychological/psychiatric establishment per se is a tool of oppression and that mental illness is a myth.” That last thesis, which I have italicized, is close to asserting that distinguishing between sanity and insanity is a social construct. Back then, Rough Times did not go so far as advising surgical and endocrinological procedures to give a simulacrum of physical reality to an individual’s claim to be really Napoleon Bonaparte inside rather than the identity assigned at birth—let alone advising this course of action for children with identity questions. Progress?

  15. This post pushed me to read what the American Academy of Pediatrics (AAP) has to say in general on this matter. It is a substantial piece :

    “Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents”
    Authors [ many – all MDs ]
    Corresponding author : Jason Rafferty, MD, MPH, EdM, FAAP

    Perhaps one might go right to Table 1, which shows a plethora of relevant definitions.

    I think it is a fine piece.

    However, [ if I can be forgiven for focusing on a general matter of language in this comment ], none of the definitions mention gametes. The AAP also has, to my dismay, adopted the language “binary”.

    I’m more of the view that “binary” is simply incorrect, as the matter of sex involves, at root, tangible, measurable, observable objects : male gametes, and female gametes. Thus, there are a set of gametes : either male, or female, so the accurate language – in my view – would be “Boolean”, even though “Boolean” is probably not as widely known as “binary”.

    “Binary” or “nonbinary” exhibit aspects of pseudoscience or pseudomedicine – adopting Big Words from the vernacular, to compensate for weaknesses in a case.

    [ apologies for length and diverting from the main point ]
    [ thanks to the edit function gremlins ]

  16. A few days ago, I searched “test transgender” and got a (German) commercial teenie website as the top result.
    I clicked and did the ridiculous list of questions on “Am I transgender — female to male” . Result: “Chances are 60 % you are transgender! Ask you parents whether your situation could be clarified at a clinic. 65 % of 11 177 participants had this result”. (!)
    I answered all questions truthfully, including clicking yes to “I am just doing this test for fun or because I am bored”.
    In the comments section below my result: A bunch of disoriented teenagers, unsure whether they are trans or not. I get the impression from the comments that wondering whether one is trans or playing at being trans is a currently fashionable thing. Several aren’t sure at all but have already taken boys’ names anyway. One girl: “For quite a while now I have felt unwell in my body”. But a penis, she doesn’t want. It’s puberty. In particular female puberty in the Instagram world.
    The current faddishness that leads to misplaced “treatment” of people who donÄt really need this will make hormone transition harder to get for those for whom this is not a game. As is already happening in the UK and Sweden.

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