A question: What is “gender-affirming care”?

May 20, 2023 • 1:00 pm

I have a serious question, and no, I’m not a Republican or a Nazi for asking it.  According to the Associated Press, 17 states have restricted or banned “gender-affirming care”:

At least 17 states have enacted laws restricting or banning gender-affirming care for transgender minors, though judges have temporarily blocked their enforcement in some, including Arkansas. An Associated Press analysis found that often those bills sprang not from grassroots or constituent demand, but from the pens of a handful of conservative interest groups.

Many of the proposals, as introduced or passed, are identical or very similar to some model legislation, the AP found. Those ready-made bills have been used in statehouses for decades, often with criticisms of carpetbagging by out-of-state interests. In the case of restrictions on gender-affirming care for youths, they allow a handful of far-right groups to spread a false narrative based on distorted science, critics say.

The “distorted science” appears to be mainly the claim that puberty blockers are unsafe. But in fact their safety is in question, and so that’s not “distorted science.”

We don’t know their long-term effects, we know they do have some inimical effects, and at any rate the lack of good long-term data has impelled several European countries to allow blockers to be used only in experimental clinical trials.

Below is what my understanding of “gender-affirming care” includes. I may be wrong, and I haven’t read the bills. but my understanding of the procedure doesn’t make me rush to assure everybody that it’s fine, and that only transphobes would support them.  To me this brand of care involves two primary ways of treating a gender-dysphoric child:

  1. My view was that “gender-affirming care” involved not a therapeutic probing of gender-dysphoric children to see if they may have been gay, and to generally explore their dysphoria—a rather long process of therapy—but rather a rush to affirm a child’s conclusion, or the conclusions of their parents, that the he or she feels as if they were in the wrong body. Instead, I thought “gender-affirming care” was what its name implied: not empathic but objective therapy, but rather a rush to affirm what the child or its parents had already concluded about gender.
  2. I also thought that “gender-affirming care” involved a willingness to use puberty blockers, and use them soon: in some cases they’ve been prescribed after just the first visit to a doctor or therapist.

It’s worth considering whether at least these two aspects of  gender-affirming care should indeed be banned for the time being.  No child’s word should be accepted without question by a therapist, especially when irrevocable medical changes can depend on whether that word is accepted uncritically. There is general agreement that gender dysphoria will resolve one way or the other (often the child becomes gay) without dangerous hormonal or surgical treatment, so why the rush??

Further, I agree with the Europeans that the use of long-term puberty blockers should be considered experimental, not just an off-label use, which is how they’re used in America.  They should not be prescribed except in clinical trials—something that the Europeans, more cautious than we in this matter—have decided.

Now there may be other aspects of these bills banning gender-affirming care that go beyond this, and to which I’d object. But the two behaviors above—banning “immediate acceptance therapy” and prescribing puberty blockers willy-nilly—are, in my view, worth halting pending further data.

Until we know that puberty blockers are safe for long-term use, and absolutely reversible, they should not be prescribed except in clinical trials, and not to the general public.  These are used either at the onset of puberty or before it begins, and a child is in no position to make a decision about its gender at that age. I’m not sure what age should be the cutoff, but surely no younger than 18. We can argue about that after the medical data are in.

And yes, I’m prepared to think that conservatives who propose these bills are doing so not solely out of medical and therapeutic considerations, but to go along with their tribe, perhaps out of a general dislike of transgender people. That is thoughtless and unempathic.

Nevertheless, I might be willing to go along with some aspects of these bans, not on political grounds, but rather on medical grounds and out of concern of the well-being of children and adolescents.

But my ignorance of these 17 bills is profound, so please enlighten me. What kind of “gender-affirming care” do they ban? Do they spell it out clearly?

81 thoughts on “A question: What is “gender-affirming care”?

  1. I feel like a lot of Dem voters kneejerk support this because of their black and white thinking: Anything Republicans want must automatically be bad, especially if Abrahamic religion comes into play. And besides, who doesn’t want to be kind?

  2. I think it includes surgical, as well as medical (i.e. drug), intervention: the NY Times had a story the other day about a girl who had a mastectomy at 15. (At the time she “thought” she was a boy; she no longer thinks so.)


  3. I recall an article where a M->F transgender through the use of hormones and whatever else and a ton of taxpayer money (it was in England) could dribble out a bit of milk to breastfeed her child. It was allowed for the psychlogical well-being of the ‘mother’.The ‘father’ of the child was the one who gave birth since he was a F->M transgender. Is that gender-affirming care, or is it childcare?

    BTW,I am not making this up. Google “Transgender woman becomes first in world to breastfeed baby Evening Standard”

    1. Male lactation is more common than many people realise. Physical stimulation of the breast and nipple has a similar effect in both men and women – it encourages the pituitary to release prolactin, which then tells the milk producing tissue to get busy. But usually, there’s not enough breast tissue in males for this to have any real effect.

      Prior to puberty, male and female breast tissue is pretty much identical in size and function, and if male breast tissue meets female hormones, it grows like it would in a female. Trans women often take oestrogen and progesterone (analogues), resulting in breast growth, including alveoli (milk making glandular tissues), milk ducts, fat and even connective tissue to hold it all in!

  4. In “gender-affirming care” the word “care” is an abbreviation of “health care”. This encompasses medical interventions (puberty blockers, cross-sex hormones) and surgical interventions (mastectomy, aka “top surgery”, and “bottom surgery”).

    The term doesn’t refer to acceptance of social transition or therapist “affirmation”, it refers to medical/surgical interventions.

    1. We tend to conflate two different usages:
      1. Afiirmation as an approach. A gender-questioning child is immediately ‘affirmed’—regardless of the ‘questioning’ aspect. Nor are their parents, teachers or friends allowed to ask any questions. Affirmation is not simple acceptance, but a positive and congratulatory welcome into transworld. See also ‘love-bombing’ in cults.
      2. Gender-affirming medical treatment and surgery. Simply a euphemism for the Frankensteinian efforts to physically warp a body into something it cannot be. These are rarely believable in ordinary circumstances, and never when you see someone unclothed. Unwanted side-effects from puberty blockers are becoming apparent (osteoporosis, cognitive changes), and lifelong cross-sex hormones are very dangerous. (Look at how we agonise over putting menopausal women on œstrogen for a few years, or prescribing the birth control pill for decades. The risks of DVT, PE, breast cancer, ovarian cancer, CVA and MI are enough to get some brands of BCP pulled from the market, but it’s OK to put youngsters on much higher doses for their whole lives?) As for surgery, it is mutilating, ugly, and at best makes a caricature of the intended body. Also it is irreversible. I have worked as a junior under urologists and gynecologists who would routinely refuse vasectomy and sterilisation requests from adults without children. Regret is the norm and legal consequences follow. But we will let a pre-pubescent child choose sterilisation, and the inability to have sex or orgasm?

      My impression is that the laws under discussion are aimed at the easier target of usage #2. It would be far better if we directed attention at #1, as without the experience of turning overnight from the confused and unpopular member of the class at school, to being catapulted into high-school stardom, fewer kids would find themselves in a gender clinic. It is much harder to write laws governing the unrecorded behaviour of teachers than it is to forbid surgeries. It is impossible to legislate peer group responses. One hopes this is a fad that will go the way of the moral panics about reefer madness and satanic cults, but there is a difference here. They were, largely, imaginary evils. The trans-fad is real, and whilst we would want to provide whatever care is best for the tiny fraction who have actual good old fashioned gender dysphoria, we can do nothing but harm for the autistic girls swept up by social contagions.

      (Apologies, PCC(E), this was longer than you like. I’ll go sit on my time-out chair.)

  5. Obviously, puberty blockers have to be given before puberty, so waiting until 18 is not an option.

    The only solution will be for society to recognize that the whole idea of transgenderism is just completely bonkers. Would “affirming care” suck what is left of the fat out of children who are too thin but think that they are too fat? There are already people who identify as amputees and some pay surgeons to do the deed. Others (like with self-ID in the transgender world) just sit in a wheelchair and pretend.

    The worst aspect is that many who consider themselves on the left are automatically against anything that Republicans support. There can be only two sides is the claim, with us or against us, and believing one thing implies you believe a whole catalog. People have forgotten that one can agree on some things and disagree on others and/or that there is a middle ground.

    There are children who think that their breasts will grow back after a mastectomy if they take estrogen, or if they get implants then they are a woman again.

    There should be a law against any sort of intervention which has lasting effects on the body. Such decisions should be taken only by people who are older than, say, 18. That includes circumcision, piercing, tattoos, etc.

    Transgenderism without surgery and hormones is just the equivalent of playing make-believe and, as we have seen, self-ID is open to abuse and is abused. With surgery and hormones, the result is not a convincing conversion to the opposite sex in any way, shape, or form.

    1. Transgenderism is a real thing. I know two people who have transitioned (in their 30s) after thinking they were gay for most of their adult lives. The transition was the right thing for them. But this does illustrate how easy it is to confuse the two states even for those involved. Especially as a teenager.

      1. I agree. Trans people do know that they are in the wrong body. Why do I believe that I should be in a male body? No idea. But it does not always align that way, that is for sure!

        1. What is the difference between someone who knows they’re in the wrong body and someone who only believes they know they’re in the wrong body? How would they — or anyone else — tell this apart?

          1. There is a distinction between knowledge and belief, but generally it’s where knowledge is a special kind of belief that has an objective confirmation. An anatomical male can say with utmost conviction and sincerity “I believe I am a woman”, but they cannot know that they are since when they look down they will see no evidence to support that.

            1. Can you tell a person who, with utmost conviction and sincerity, says “I believe I am a woman”, from a person who, with utmost conviction and sincerity, says “I want to be a woman”? One is a “real thing”, the other is a social construction. (You can’t tell.)

          2. This can be difficult, but the biggest tell is whether it has been present since early childhood. True gender dysphoria (rare) is marked by early expressions of dissatisfaction with one’s lot.
            The final way of knowing is useless as a tool: do they stay happy after transition? Real gender dysphorics generally do. They get on quietly in their new lives. My expectation is that those who get rail-roaded into it whilst confused as a teen will not, and that there will be a huge wave of detransitioners who are going to be angry.
            Our real failing in this is that the affirmative approach forbids any attempt to sort out one from the other.

        2. How, other than via gender stereotypes about how women look, feel, and behave, can a man believe that he is “really” a woman?

          1. Given the sincerity and consistency from those who claim to be in the trans spectrum, I can only surmise that the experience is comparable to the experiences of cis people. Only also different. Like us, it’s something in our heads, although we don’t know how or why. You and I may believe we should be men, and ‘sho ‘nuf our anatomy aligns with that. But others can believe, from somewhere in their mind, that they should be a women while their anatomy says something quite different. I can’t imagine what it’s like. But given that they face a difficult life while they still insist on it, I am quite convinced that it is as real to them as our gender ID is to ours.

        3. So you are accepting the mind/body dualism that is necessary if one can be said to be born in the ‘wrong’ body.
          And now I have an image in my head of an underpaid, overworked sap in a celestial Amazon warehouse getting fired for sending wrong gender souls to foetuses.

        4. There is no such thing as being in the wrong body. It’s all about liking what you see in the mirror. A man who likes seeing himself dressed as a woman is still a man, not someone who was born in the wrong body. Half my wardrobe is menswear but I’m still a woman.

      2. What though does it mean to be “transgender?” The common definition — “someone whose gender identity (belief about what sex they are or should be) doesn’t match their sex” — is often folded into an explanation for why this is the case. This then leads to confusion, where disagreements about the cause turn into charges about what’s real or not.

        1. To be transgender is to want to be the sex you’re not. No wonder it leads to confusion. The desire is real enough, and there’s plenty of ways to mimic a change of sex. But you can’t change your sex and there’s the rub.

      3. But how do your acquaintances know now they weren’t really gay then?They say they were wrong then. How do they know they aren’t wrong now that they are really women? After all, they are still presumably sexually attracted to men. So what really has changed except a penis that doesn’t get fully erect anymore?
        And if transgenderism is a mental illness, it’s still a “real” thing. It just isn’t necessarily what the sufferer thinks it is just because the sufferer thinks it is.

        Vertigo is real. People have vertigo that can be disabling. But the room isn’t really spinning. The brain is having a hallucination that it is. You don’t treat vertigo by demanding the room be tied down so it can’t spin, even if the sufferer thinks this would be the right, sensible thing to do.

        1. There needs to be more research into this. The human brain apparently has some average differences between the sexes (and that is also true for other species). But we don’t know how that translates to cis gender identities, or if these differences are induced to be modeled that way because of gender identity.
          Meanwhile, I believe I’ve read somewhere that there are some alterations in the brains of trans people that align a bit with their gender identity. So that could once again be a cause for their gender identity, or, once again, the brain differences could have been induced because of their lasting gender identity.

          1. “There are some alterations in the brains of trans people that align a bit with their gender identity.”

            Yes this is true, but for the most part these differences are accounted for by same-sex sexual attraction. Studies like this

            Burke, S.M., Manzouri, A.H. & Savic, I. Structural connections in the brain in relation to gender identity and sexual orientation. Sci Rep 7, 17954 (2017). https://doi.org/10.1038/s41598-017-17352-8

            show sex differences in brain structure between males & females. Male transwomen and female transmen do show some traits characteristic of females and males (respectively), but those traits are associated with same-sex sexual orientation. In that sample, many of the trans people were simply gay; after controlling for same-sex sexual orientation, transwomen had male-typical brain structure and transmen had female-typical brain structure.

            1. The differences, even the statistically significant ones, are quantitatively small and there are six groups to analyze variance. (The actual MRI methods are above my pay grade.) There was a difference in one white-matter tract (of 13 tracts studied) associated with gender dysphoria itself that the trans people of either sex were more likely to display, if you trust their statistics. This tract was in the right parietal lobe which (in almost all right-handed people and about half of left-handed people) governs perception of body image.

              People who have strokes in that part of the right brain may believe that their left arm and leg belong to someone else even if the limbs aren’t paralyzed…or they can’t recognize faces. So it’s tantalizing to think there is something in the way the brain is wired up that causes someone to think he has the wrong genitals…on both sides, though. Arguing from what we see in strokes, he should be OK with his right testicle but the left one doesn’t belong. I’m skeptical that this study shows what they say it does. It’s pretty subtle. It’s also 6 years old.

              1. I think all they’re saying in that study is that trans people don’t have the brain of a person of the other sex, they have the brain of a gay person. But maybe I misread it.

              2. There were several small differences between sexes that tracked sexual orientation, as you say, and one that did seem to track with body image in the trans people.

    2. Part of the problem with the quality of evidence used to support medical interventions for youth is that much of the data come from self-reports that include many errors. The largest dataset


      includes respondents who said they received puberty blockers on or after 18 years of age when puberty would have been well under way or complete. One interpretation is these people were receiving cross-sex hormones (not puberty blockers) starting on or after 18 years of age, but didn’t know the differences between puberty blockers and cross-sex hormones.

      The survey also included an unusually large proportion of respondents who said they were exactly 18 years old (among other problems with the non-representative nature of the sample).

      That kind of basic misunderstanding suggests that much of the data from these self-reports is suspect at best. Jesse Singal and others have reported on these flaws in the USTS data.


    3. Yes, there are people who really, really believe that they were born in the wrong body. So? There are people who really, really believe that God exists, yet that doesn’t convince me that God exists. Similarly, their belief corresponds to no objective reality.

      In any case, the idea that, whether one believes one was born in the wrong body or not, with hormones and surgery one can somehow really become the other sex is as bonkers as believing—though many do—that bread and wine are really the body and blood of Christ.

      And children who are led to believe that are often severely disappointed.

      1. The phrase ‘born in the wrong body’ is one that makes the so-called sceptics who have taken up the trans cause (looking at you, Myers and your Horde) very uncomfortable and one they will avoid using at all. Why? Because it clearly implies the mind/body dualism that those ‘sceptics’ happily refute in the case of religion but are forced to accept for the trans issue.
        This forces them to invent other mechanisms by which males can really be females and vice versa, and has led to the obfuscation that one sees in Myers’ Gish-gallop-style posts on the subject, blending such irrelevancies as chromosome combinations, zebra fish, seahorses and the colour spectrum, among much else that has nothing to do with transgender, to make his case.
        The one cause that they absolutely refuse to consider is that transgenderism is a uniquely psychological condition, because despite it being true, it makes a lie of the ‘trans women are women’ mantra which lies at the heart of the current fashionable nonsense.

        1. There’s an alternative to dualism and that is that male and female brains are different, but that is also pretty uncomfortable for Myers et al to contemplate.

          1. It’s uncomfortable for him because having distinctly male or female brains – whether in the ‘wrong’ bodies or not – would be further proof of the sex binary.
            In order to fit with trans dogma the male/female brain hypothesis would need to include (yet another) spectrum. At one end, a brain that is 100% female, a 100% male brain at the other, a precise 50/50 split in the middle and infinite graduations in between. To further complicate matters, a lot of new brain models would be required; some must be completely outside of the male/female binary for the non-binary types who claim their genders as neither male nor female but whole new, as yet unnamed genders; more will be needed for all the new sexes (because even PZ accepts that sex and gender are different – until they aren’t!) that Myers claims exist, fails to name, but proves their existence by telling us of the spectrum of colours that gets wider the closer we look at it.
            And then there has to be at least one brain type without a fixed structure but which can instantly morph between sexes’ and genders because ‘gender-fluidity’ is a valid identity, too. Quite how that brain would perform such a feat is above my pay grade.

            *and now I’ve typed it out and read it through, I can’t understand why PZ would be uncomfortable defending such a hypothesis; I’m sure he can find some obscure lifeform on which to base a comparison. Failing that, he could always borrow from astronomy and point out that not all stars fit into the main sequence, therefore not all brains fit into the m/f binary.
            Why not? It’s actually no less daft than the defences he’s used so far.

            1. I can tell you exactly why he’s uncomfortable with the hypothesis. It’s because of his rabid antipathy to evo-psych.

              Before trans gender became the issue de jour, he was a militant feminist and the idea that male and female brains are different would provide an explanation of certain types of discrimination. For example, you could argue that the relatively small number of female mathematical geniuses is due to is not due to institutional sexism but differences between male and female brains. The idea that male and female brains have evolved for different roles in society is anathema to PZ.

              Perhaps the reason why he is so aggressive with respect to trans issues is that none of the possible explanations for why there are trans gender people is palatable to him.

  6. I’ve been reading about this issue intently for couple of years now. And one of the main things, apart from being gay, that fascinated me were euphemism like “top surgery”, “bottom surgery”, and especially “gender affirming care”. What exactly were these things? (By reading, I mean that I had to leave “mainstream media” and read people like Jesse Singal, Abigail Shrier, and Lisa Selin Davis among others….and yes, it took me a while to find out about them.)

    “Gender Affirming Care” can be contrasted to the original more European model called “Watchful Waiting”. Gender affirming care is far more aggressive and it’s what proliferates in the United States, especially “blue states”. And as it turns out, the states that are banning procedures, mostly “red states”, will have rules that are actually closer to that of “Watchful Waiting”.

    As a note, I believe that Tavistock in London had adopted the more aggressive American model of “Gender Affirming Care”. And as you may know, it was ordered shuttered after the Cass Report….you can google all about that.

    Let me recommend some great articles to you:

    This one from yesterday by Andrew Sullivan:

    This by James Kirchick in Liberties:

    And this one by Lisa Selin Davis in Unherd:

    1. “Gender Affirming Care” can be contrasted to the original more European model called “Watchful Waiting”

      Which the trans advocates have labeled – with their trademark disregard for the truth – ‘conversion therapy’.

  7. This is a hot topic here in Oregon right now because of Oregon Bill 2002, which passed the House and is now in the Senate. Enough Republicans have walked out to prevent a quorum for voting on the bill, this despite the fact that they’ve surpassed the number of missed sessions that will prevent them from running for re-election. I too am a bit confused as to what “gender-affirming care” means in the bill, but one has to have a grudging respect for Republicans to put their careers on the line on matter of principle, the principle in this case being that gender-affirming care, along with abortion at any age, would be allowed without parental consent.

    1. They should not be grouping abortion and gender affirming care together. The decision to abort a pregnancy has urgency – in most cases a girl can’t wait till she’s 18, and abortion carries far fewer health risks than carrying a child to term and giving birth.
      There is no such urgency in gender affirming care, which sadly is much more damaging to a child’s health than watchful waiting.

  8. The AP article mentions that most bills are based on model legislation. In particular, they note similarities between proposed legislation and a model by a group called “Do No Harm”. This is a link to the Do No Harm model legislation, with annotations that indicate language similar or identical to that in proposed legislation in various states.

    Here’s my attempt to summarize the model legislation as briefly as possible:

    – Begins with a section critical of the affirmation model, citing controversies over evidence, the trends in Europe, etc.

    – Provisions for public schools, including parental notification of gender questioning children, a prohibition of using pronouns inconsistent with natal sex, and prohibition of discussing social or medical transition with students.

    – Prohibitions of using state money or other resources for transition, including no funds or tax breaks for any medical procedures, facilities owned by state or persons employed by the state may not be used for medical procedures, and state employees may not promote social or medical transition.

    – Prohibitions of medical procedures for minors, including puberty blockers, cross-sex hormones, and surgery, except when addressing a DSD condition, or treatment of some disease, injury, or condition unrelated to gender concerns.

    – Healthcare professionals who perform prohibited procedures are subject to suspension of one year and can be sued by parents.

    – Minors who received gender related procedures and experience physical or psychological injury can sue the healthcare provider up to 25 years in the future.

    – Medical liability insurance doesn’t apply to procedures prohibited by the legislation.

    1. Replying to my own post to comment about that last bit about liability insurance. I assume this would be added to legislation to force healthcare providers to pay out of their own pockets any damages from individuals who were harmed by procedures they performed. It sounds like just punishment to make them pay for it themselves, but I think this actually a terrible idea.

      When healthcare providers are sued, typically lawyers will take the case on contingency, with the hope of a big payout from liability insurance. Without that, individuals would have to pay lawyers upfront, which few could afford. That would significantly limit that number of cases that actually proceed.

      It’s only lawsuits that will end unnecessary procedures for minors in the US. And that can only happen if enough lawsuits go through.

  9. So glad this is a topic. I was afraid I had been bitten by a Republican bug. California passed a gender-affirming care bill some time ago and I’ve been against it ever since then. It overrides parents’ objections to the procedures! The children are in the driver’s seats. Do it or I’ll kill myself is a way for a bully to be in control.

    1. Overriding the objections of parents is how you turn those parents into voters for Republicans, This is what Youngkin saw in Virginia and capitalized on, in that case the issue was ignoring objections of parents to school policies. It is distressing to see the policies of trans activists making it harder for Democrats to win. Democrats need to take seriously the doubts and dissatisfactions about policies like those pushing so-called affirmative care. We should also see the phrase “gender-affirmative care” as like “pro-life”, in being an activist slogan, not a serious description.

    2. Borderline personality disorders behave that way, too, Christine. Bullying of the strong by the weak.

  10. In the UK, at least, “gender-affirming care” is a wide spectrum including everything from “social transitioning” (the changing of name, appearance, and pronouns to meet some stereotypical idea of the opposite sex) to puberty blockers and ultimately cross-sex hormones and surgery.

    Dr Hilary Cass, a former President of the Royal College of Paediatrics and Child Health is currently leading an independent review into gender identity services for children and young people in England and Wales. Her Interim Report noted that “social transition […] may not be thought of as an intervention or treatment, because it is not something that happens within health services. However, it is important to view it as an active intervention because it may have significant effects on the child or young person in terms of their psychological functioning. There are different views on the benefits versus the harms of early social transition. Whatever position one takes, it is important to acknowledge that it is not a neutral act, and better information is needed about outcomes. […] It should also be recognised that ‘doing nothing’ cannot be considered a neutral act”. [Independent review of gender identity services for children and young people: Interim report, pp 62-3]

    For those interested, the Interim Report can be downloaded here: https://cass.independent-review.uk/publications/interim-report/

  11. “Gender-affirming care” is in some ways the Left’s version of “enhanced interrogation”. They are doing it to save people: How dare you ask for or criticize the details of what goes on behind the euphemism. Don’t you care about saving people? If we listen to you, then people will die!

    But, unless I missed something, even the “enhanced interrogation” folks did not cut healthy body parts off children.

    Interesting thing, politics. During the Iraq debacle a number of veterans stood in opposition side-by-side with people who in an earlier war would have spit on those same veterans. What strange alliances might Wokeness make?

  12. I’ve had several trans friends over the course of my life, but they were always adults. They were and are well-adjusted people I love. But they are rare. I also have friends from when I was in grade school who were very gender non-conforming (the kind of kids adults can tell are gay before the kid even has a concept of sexuality) who, when I’ve asked, have said they fear what their life might have ended up being if they grew up in today’s environment. They may have said one day that they felt like a girl or a boy, and been pulled aside for “gender-affirming care,” and been manipulated into something that changed their futures from happy, gay adults to miserable people who had “choices” foisted upon them by those who were supposed to protect them. And that’s what scares me most.

    “Gender-affirming care” is a very pleasant-sounding colloquialism for “believing and reinforcing what the child says, usually immediately, and sometimes even immediately providing hormones and/or puberty blockers.” Yes, it can differ from place to place, but what I’ve described is honestly scary, considering the scale at which it’s taking place in the US.

    Remember the Satanic Panic? Children can be convinced by adults of nearly anything. Children were convinced by medical professionals that they had repressed memories of satanic cults sexually abusing them. They believed in it so completely that their testimony destroyed lives (watch a documentary called Capturing the Friedmans). If psychologists and psychiatrists can convince children of that, how easy must it be to convince a child who has already just had the thought even for a moment (maybe even only that very day!) that they are indeed a sex trapped in the opposite sex body? Unlike the children in the Satanic Panic, these children are already primed (by themselves, online forums and activists and “support groups,” media, and even sometimes their own educators/curriculum) to believe they are trans, and now they have an authority figure telling them that they’re absolutely right.

    Now, also consider the comorbodity of depression, autism, bipolar disorder, and many other mental health issues with people who identify as (but don’t always turn out to be) trans. This makes them yet more vulnerable.

    What child would ever turn back from thinking they’re trans when everyone and everything around them is telling them it’s true, and they’re often mentally vulnerable as well? If it turns out they weren’t trans, they’ll only realize the horrible mistakes they made — through no fault of their own — once the permanent damage has been done.

    I’m not denying the existence of trans people. There are certainly people out there for whom transitioning is the correct choice. But even across Europe — a place that’s usually far to the left of the US (especially places like the Nordic countries!) — we have seen countries back off from “gender-affirming care” to the much more sensible “try to objectively evaluate a person’s potential mental health issues, see if there may be other factors at play, and do your best to keep from giving experimental drugs and irreversible surgeries, especially to minors.” I feel like the “gender-affirming” approach, especially in its most extreme forms (experimental drugs, mastectomies, slicing penises in half and creating a “neo-vagina,” etc.) will be looked back upon ten or fifteen years from now the same way we looks at random brain-scrambling labotomies and using hysterectomies to cure women who are “hysterical.”

    I’ve had several trans friends over the course of my life and one now, but they have always been adults who started transitioning as adults. They were and are well-adjusted people I love. But they are rare. I also have friends from when I was in grade school who were very gender non-conforming (the kind of kids adults can tell are gay before the kid even has a concept of sexuality) who, when I’ve asked, have said they fear what their life might have ended up being if they grew up in today’s environment. They may have said one day that they felt like a girl or a boy, or just for “acting like” a girl or a boy (man, the trans movement has really brought back gender stereotypes!) and been pulled aside for “gender-affirming care,” and been manipulated into something that changed their futures from happy, gay adults to miserable people who had “choices” foisted upon them by those who were supposed to protect them. And that’s what scares me most.

    1. Nice to see someone seeing the parallels between Repressed Memory Therapy and ‘Gender Affirming Care’ it all comes down to them holding the belief that they have the ‘One True Cure’ to mental issues.

    2. “Remember the Satanic Panic?”

      Diane Ehrensaft in 1992:

      Ehrensaft, D. (1992). Preschool child sex abuse: The aftermath of the Presidio case. American Journal of Orthopsychiatry, 62(2), 234–244.
      “A case study is presented of girls who were among the preschool victims of sexual abuse linked to occult rituals that occurred at the Presidio Army Base Child Development Center.”

      Diane Ehrensaft in 2014:

      Diane Ehrensaft (2014) Found in Transition: Our Littlest Transgender People, Contemporary Psychoanalysis, 50:4, 571-592
      “boys really can become girls, and girls really can become boys, and some can become neither/nor or both/and, with none the worse for wear. So, in answer to the question, “Can we recognize when a young child is transgender?” I hope to have demonstrated, “Yes, we can.””

  13. If one completes all elements of gender-affirming care, will the gender dysphoria be considered cured?

    1. Becky’s point is important. You cannot tell by treating someone according to a certain protocol whether the treatment is successful, unless you have defined beforehand what counts as success. See discussions by Jesse Singal of how some trials of various forms of affirmative care have switched what they are supposedly looking for between the initial account of what they are trying to establish and what they wind up reporting.

      1. A recent Jesse Singal study that is particularly illuminating is available on his Substack, from April 14, 2023, entitled Here’s more evidence that Youth Gender Medicine Researchers might be hiding unfavorable data from the Public. Singal is good at using Freedom of Information laws to extract data about design of studies and what they actually show.

        1. My favorite example of the evidence used in support was a question used as part of an assessment of the level of distress from gender dysphoria in M -> F transgender kids during treatment:
          “When I have a menstrual cycle I feel distress [0-none to 5-severe]”
          Obviously they all answered “0”
          Conclusion? See, we are helping them.

          This kind of garbage being used as proof is one reason all the pediatricians I know are referring all these kids out of state. The resistance to legitimate discussion and performing valid studies has scared everyone off (that and the lawsuits that are sure to come).

          At least the bills prohibiting affirmative care excluded the disorders of sexual development, these people need to be remembered and protected during this debacle.

  14. I repeat my offer to unfortunate individuals who find themselves born in a human body, when their internal soul tells them that they really belong to a different species. For an appropriate fee, my clinic will provide reassurances, experimental hormone treatment, and false fur. We call our program “affirmative affirmation”. The treatments cost an arm and a leg (or, as we prefer to say, a paw and a hind limb), but we like to think that we are doing well by doing good.

  15. Every part of the phrase “affirmative care” is deceptive newspeak.

    “Affirmation” is simply a public statement that you believe something is true. In this case, children have been convinced that they have been born in the wrong body by persuasive adults, and shady mental health and medical professionals affirm the child’s delusions.
    Almost all of it relies on deception. The kids are led to have completely unrealistic expectations of the outcomes. When the current stage of the process does not yield satisfactory results, they are told that the next stage is the one that will lead to all of their problems being solved.
    In that way, it is much like Scientology.

    Children can be convinced of just about anything. The more absurd the proposition, the harder the sell, graphed against the age of the child.
    A persuasive adult, given time with a child or group of children, can convince them that they are all born in the wrong bodies, that they need to sign up for a timeshare, that there is a monster in their closet, or that they will be saved if they bathe in the blood of the lamb. Or that they are the personal reincarnation of Elvis or Napoleon. Whatever.

    “Care” is positive attention to one’s needs. Care implies positive outcomes. Nobody knows what sort of long-term effects will result from giving puberty blockers to healthy kids. My personal impression of puberty blocker kids is that they show symptoms that look a lot like fetal alcohol syndrome.
    Hormone therapy for healthy kids results in depression in every example I have encountered. So they are prescribed drugs to even out those effects, and other drugs to balance out the tertiary effects. It is a tightrope that they will occasionally fall from.
    Surgical intervention is not care, either. Taking a healthy child, sterilizing them, and forming a crude approximation of genitals is not care, or reversible. Nor will it ever allow them to actually experience life as a member of the opposite sex.
    There is a need for such techniques in cases where the child has suffered some sort of disfigurement or birth defects. Doing this to a perfectly healthy child is Mengele- level harm.

    1. “Children can be convinced of just about anything. The more absurd the proposition, the harder the sell, graphed against the age of the child.”

      Yep, that’s why the Jesuits (and the Baptists, Southern from my childhood experience), want to get ahold of them while they’re young.

      I’m reminded of increasingly hearing the phrase “abortion care,” especially on NPR. Pray tell, what is the difference between “abortion care” and “abortion”?

    2. “Children can be convinced of just about anything.”

      The above ties in with your post of the other day. It isn’t the cartoon pornography that is the goal in pushing such books into the libraries and grade schools; the goal is to advance gender ideology throughout K-12. Any such graphic books are just nice-to-have-but-ultimately-unnecessary supplemental materials. Parents who think they have won something by simply removing those books never really understood the real battleground.

      1. At the risk of violating the rules by dominating the discussion, kids do not naturally want to discuss their genitals or sexual feelings with teachers or school counselors.
        There are plenty of videos on the internet where teachers explain how they work to get students into such conversations.
        That is also why the term “grooming” is often used. When a creepy neighbor wants to groom your child, they first establish trust and build a framework of secrecy from parents and others. Once secrecy is established, they show the child graphic sexual images and attempt to normalize such behavior in the child’s mind.
        That is exactly what is being done in schools, and why some people think it is very important that young kids be conversant in topics like anal sex.

  16. I don’t see any answers to Jerry’s question about what these state bills against gender-affirming care actually would make illegal. The law to be enforceable has to state exactly what may not be done. If anyone who lives in a state proposing a ban could cite the relevant clauses that would be a big help. Typically we think of
    -puberty blockers
    -cross sex hormones, which would (or wouldn’t) include androgen blockade in pubescent (or later) boys
    -counseling that validates the child’s self-declared gender and inoculates him/her against efforts by others to change his/her mind
    -age restrictions
    -degree to which schools must disclose to parents that the child is socially transitioning
    -active participation by schools in encouraging or facilitating transition without disclosure to parents or in opposition to them.
    -disputes, especially between estranged custodial parents who disagree on what that is allowed by the law will actually be done.
    You can see how a blanket ban eliminates conflict within the child’s circle of care. But are there allowable exceptions? On what grounds?

    1. My response (#9) did respond to Jerry’s question. I link to model legislation on which some of the bills are based. Of course, there would be state-by-state differences in the actual ones proposed.

      1. OK, right you are. I didn’t interpret it that way, clearly not getting the drift of what the expression “model legislation “ refers to.

    2. I have read the Texas bill, and it prohibits a list of trans surgeries or sterilization of children, as well as puberty blockers and sex-change hormones
      Exceptions are made for the standard medical conditions for which these techniques were normally used, such as precocious puberty or medically verifiable genetic sex disorders.
      The primary penalty for violating this is loss of professional license.

  17. “What is “gender-affirming care”?”

    As detailed above, I do not know the answer. But a related perhaps rhetorical question seems to me useful :

    Has everyone already been getting “gender-affirming care” all along and not known it as such from ob/gyns, urologists, or primary care physicians, and so on?

    That is, isn’t lots of “care” already implicitly gender affirming, and if not, then why this discrepancy? Akin to the “alternative medicine” v. “medicine with no special names” discrepancy.

  18. I am opposed to “gender-affirming” [health]care. It is not the job of the medical profession to affirm a patient’s self diagnosis; it is to provide an independent, objective diagnosis and then appropriate “gender transition” healthcare. [Yes, I am all for “gender transition” healthcare.] Family and friends need to provide the “affirmation” part.

  19. “As the world goes mad, Florida represents a refuge of sanity and a citadel of normalcy.” – Ron DeSantis

    DeSantis and wo/men of his ilk really are homophobic and transphobic. They don’t want gender-affirming care, because they don’t want anybody to care about homosexuals and transsexuals. Be “sane” and “normal”, or be damned! So we old-school lefties find ourselves in a two-sided culture war against the wacky transgender wokesters on the left side and against the “God told me he doesn’t like faggots&trannies” sort of people on the right side.

    1. Have you seen something that suggests DeSantis is in the “God hates fags” category? If so, could you post it?

      Why can he not have the same objections to or concerns about gender ideology that many of us voice regularly on this site? Are such concerns proof of “homophobia” and “transphobia”? Or perhaps his party affiliation is all we need to know to read the man’s mind. Shades of difference on this side; one undifferentiated mass over there.

      And, by the way, if you haven’t already read the piece by Andrew Sullivan that Jerry linked to earlier, it’s worth reading. The charge of “homophobia” against anyone who questions the wisdom of sex changes in children is simply ridiculous.

      1. “As the world goes mad, Florida represents a refuge of sanity and a citadel of normalcy,” DeSantis said during his signing ceremony /at a Christian school/.

        I agree that “the charge of homophobia [transphobia] against anyone who questions the wisdom of sex changes in children is simply ridiculous,” but DeSantis isn’t just anyone who does so. Aren’t you aware of DeSantis’ overall position in the spectrum of political ideologies?
        Both he and I reject postmodern (trans)gender theory, and yet we are worlds apart. Both he and I think transwomen aren’t women, and yet we are worlds apart. I’m an atheist, a secularist, a liberal social democrat (what is called a “communist”/”socialist” in the USA—ha-ha!), who cares about the well-being of sexual minorities—and he is not.

        1. I agree that even casual foreigners are aware that Gov. DeSantis would not have much common ground with an atheist liberal social democrat such as yourself other than that he agrees broadly with you on trans issues. But that just means you wouldn’t vote for him if you lived in Florida or if he runs for President. Fine. Don’t. You go on to make the specific claim that you care about the well-being of sexual minorities — by this I take it you mean homosexuals since you’ve sort of written off transgender ideologues yourself — and he does not. Can we look at this?

          OK, I’ll accept that Gov. DeSantis appeals to that part of the Florida electorate that doesn’t much like either homosexuals or transsexuals and lumps them together as sexual deviants. They have a right to feel that way, if they do. But what has he given to them in the way of restricting or harming the “well-being” of homosexuals? Repealing sexual orientation as a prohibited ground of discrimination in employment or public accommodation since 1992 would be one obvious act, which he has not proposed. Whether he would secretly like to, I don’t know. (Gender identity is not now a prohibited ground.)

          The intent of the so-called “Don’t Say Gay” Law signed 17 May as it relates specifically to homosexuality is to avoid normalizing homosexuality (and gender confusion) in school indoctrination. Schools can’t mention it below Grade 8 and from 9-12 mention has to be age-appropriate. If a book for kids below Grade 8 has a gay character, then no, the teacher can’t use it. That’s all the law says about homosexuality. Kids who have two mothers or two fathers are not the business of the teacher to explain to other K-8 kids that it’s because they are gay and what that means and how they get each other off and what sort of lube they might use. How does this harm the “well-being” of homosexuals? It might not celebrate them with Pride flags and give them the public prominence as homosexuals they feel they deserve but every TV ad does that now, so it’s not like kids will never encounter positive images of gay people.

          The other provisions of the law relate to sexuality in general without specific reference to homosexuality. The law doesn’t require the schools to teach, for instance, that anal intercourse is particularly risky for transmitting HIV, even though that is true. Mentioning anal intercourse in sexual health even if it leads into homosexuality would be permitted under the age-appropriate rubric for 9-12.

          The main thrust of the law is to ban gender-affirming care in minors, even socially. This is a good thing. If a particular religious constituency allied with a child-protection constituency to get the bill through the legislature, fine. That’s politics. But there is nothing in the law to encourage gay-bashing…or even tranny-bashing.

          The activists, as they do for all trans issues that annoy them, have tried to paint the law as an attack on the “LGBTQetc Community”. But almost all of its language deals with the T part, leaving the LGB folks alone except the K-8 mentioning clause. Painting it as a “Don’t Say Gay” bill was clever propaganda because it makes it sound like it’s a gay-bashing bill when really it isn’t at all.

          A link in the story gives a pdf of the law as passed.

          1. I’m puzzled by Leslie’s comments… On the one hand, the comment states “the intent of the so-called “Don’t Say Gay” Law signed 17 May as it relates specifically to homosexuality is to avoid normalizing homosexuality… in school indoctrination”. Then in the same paragraph, insists this doesn’t harm “the well-being of homosexuals”. Isn’t it possible that there is harm in teaching kids that homosexuality isn’t normal? As a gay man, I grew up hating myself because I wasn’t “normal”. It sure would have been nice to have learned at a young age that it was. It seems to me that it’s quite likely that teaching young children that it is okay to be gay, would result in fewer teen-age suicides, fewer homophobic adults, and perhaps, fewer kids that would want to transition.

            1. The law doesn’t require the schools to teach that homosexuality is abnormal, Don. The schools are simply to stay out of it from K-8. While I respect your views I would vote for Florida’s law and those who had a hand in it as protecting children. As I said, it’s not the job of the schools to help pre-pubescent children figure out their future sexual orientation. I can’t imagine discussing my personal “latent” (Freud, sorry) sexuality with a teacher at that age and I’m mystified why schools would want to do this except to show parents who’s boss. Looking back, I’d get the creeps if a teacher was trying to tell us in Grade 6 or 7 that it’s OK to be gay. The law may be speaking to fears like that in present-day parents who are entitled to the sincere belief that homosexuality is deviant and the schools shouldn’t be normalizing it before it happens. It can be discussed age-appropriate from Grade 9 up. Your arguments for the benefits of normalizing homosexuality for pre-sexual children are unproven.

              1. Leslie, so you believe you are “protecting children”… from what exactly? LGBT youth already have a higher risk of suicide so what are you protecting them from? Why should the law validate the (strictly religious) belief that homosexuality is “deviant”? Your statement that the “benefits of normalizing homosexuality for pre-sexual children are unproven” could easily be disputed by looking into the studies of childern raised with same-sex parents. I’ll quote one: “children of same-sex parents fare as well as, or sometimes even better than, their peers raised by heterosexual parents.” (From Gartrell, N. Author, & Bos, H. Author. 2018. The children of same-sex parents: Are they
                well-adjusted?) If your view that it’s harmful to children to learn that that homosexuality is a normal aspect of human sexual behavior were true, wouldn’t studies such as this one reflect that? I understand this forum is not conducive to exchanges back and forth and this is somewhat off-topic so this will be my last comment on this matter. Besides, stating that the 12-year-old you would “get the creeps” to find out it’s okay to be gay is certainly revealing.

          2. This is not a discussion forum, so I cannot give you a point-for-point reply; but there is no doubt (see link below!) that DeSantis and his allies see themselves as Christian crusaders against wokeism, by which they don’t only mean postmodern socialism (with its “critical theories” such as gender/queer theory and critical race theory—which I reject too) but LGBT-accepting leftism in general. They want to throw the baby out with the bathwater, so to speak. The “refuge of sanity” and “citadel of normalcy” DeSantis is referring to is not a place where LGBT people are welcome.

            Ron DeSantis: the Catholic rival feared by Trump: https://catholicherald.co.uk/ron-desantis-the-catholic-rival-feared-by-trump/

        2. Homophobia & transphobia are not the same thing. That said, keeping puberty blockers & other so-called “affirming care” away from children is the responsible thing to do. If a child cannot consent to sex, then that child cannot consent to medical care, nor can that child have any concept of their sexuality or being in the wrong body. Let them grow up & for heaven’s sake, let them have an active imagination without telling them it’s reality. ALL kids pretend to be someone that they are not & sometimes that person is of the opposite sex. SO WHAT already. Leave them alone to play without making it the rest of their lives.

          1. I really don’t mean to nit-pick but I do think this is important. A child under the legal age (16 in Canada) cannot consent to sex under any circumstances. An emancipated minor can consent to (or refuse) medical treatment on her own under certain conditions, which often get litigated. Sometimes the courts will accept the child’s position, sometimes they won’t. The reason for the difference is that with sex, the other party is likely exploiting the child for his own gratification and so, to protect the child, the adult can never rely on the “consent” of the minor. In medical treatment, which ought to have as its only goal the benefit of the child, the decision is more complex. The emancipated minor situation usually arises in children who have been struggling with a childhood cancer like leukaemia for several years —they have become wise beyond their years by necessity— and, in relapse at 15, decide they’ve had enough. Their differences with their parents might involve the whole treatment plan or just one specific component, like blood transfusion.

            Your main point that children too young to consent to sex should not be able to consent to treatment that will affect their sexuality irreversibly is certainly correct, especially given the mental disturbances that make most of these kids anything but emancipated minors. I would go further and say that even parents should not be able to consent to this treatment on behalf of their children, nor should child protection services. That is, of course, what the laws accomplish.

    2. Leaving aside DeSantis, there is a very strong case to be made for affirmative care being homophobic. Patients, their parents, and—seems—therapists and society at large would rather have fake girls and boys than real ones who are gay. Remember that before affirmative care, watch and wait was the norm, and most kids would ‘desist’ and 70-80% would grow up into happy, normal gay people? An awful lot of gay lives have been ruined before they properly started by this mess.
      There are other sociological aspects to this. Girls facing puberty, and the sexual complications they will have to navigate have, in effect, said “No!” in the past by being anorexic. Is this not similar? Some girls look at the way society has treated them compared to boys, and quite reasonably think they would rather play for the other team as it always seems to win. Then there are the men who cynically parasitize this situation, and demand access to women-only spaces as a further method of control and domination.
      The more you think about it, there’s a hell of a lot of homophobia and misogyny in the trans movement!

      1. The queer theory activists want people to take transgressive and controversial stances. Gay people may have once been so, but they are pretty much accepted now. Thus, conventional same-sex attracted people are of no further use to the activists.
        Sociological factors are definitely a big part of the trans issue. The majority of kids convinced to join are at the stage where they are starting to not just notice, but to idealize the opposite sex. At least for the kids who are not gay.
        I have said before that my observation is that their desire is to live as they imagine life is for the opposite sex, a view shaped significantly by their own biological sex. The idealized view is not the reality that members of that sex experience.

        I remember some movie where some guys were talking about girls, and one of them said that if he were a girl, he would never get anything done, because he would be constantly playing with his boobs.
        If he were a girl, he would not be fascinated with boobs.

        Many, possibly most trans kids are not gay. They become “gay” after their social transition. My son decided he was a trans girl. But the dates he brings home are all of a type. Petite, pretty young girls who we are supposed to pretend are boys.

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