What if Your Child Was Trans?

I have for years been an advocate of trans rights. This includes the rights of trans youth and their parents, with the guidance of their doctors, to pursue whatever health care they see fit. I see this freedom as life-saving.

That said, I am from a rather conservative background, in which many people I know disagree with this stance.  Anyone who has been involved in the libertarian movement over the last decade inevitably knows people with deeply transphobic and reactionary beliefs. As such, I inevitably get questions, often accusatory, about how I would deal with having a child with gender dysphoria. These are questions like “Would you encourage them to identify however they like and sign them up for puberty blockers at the first opportunity?” Or “Would I be completely fine with them having their genitals surgically altered at some unbelievably young age?” I’d like to take the opportunity to answer these questions by discussing what I would do and what I would not do.

If I was the father of a child, whom I recognized as a boy since birth, and that child, at the age of five, claimed to be a girl or said he wanted to be a girl, what would I do? If this was just a one-off event or short-lived phase, I would probably presume he was testing my reaction, entertaining a thought experiment, looking for attention, or motivated by jealousy towards his female peers. It might spark some conversation, but I doubt I’d react strongly, and it would likely be forgotten in a day or two.

If, however, the child in question has a persistent, insistent, and consistent belief that ought to be a girl and continuously expresses this belief unprompted for years on end, between the ages of 5 and 10, if this belief simply would not let up, and this child routinely sought out opportunities to engage in stereotypically feminine activities and wear feminine clothes without any sign of this being externally encouraged, then yes I would take further action.

I would try to avoid actively encouraging or discouraging this belief. However, I would ask many questions: “What do you mean? Where did you get this idea? What makes you think this, etc.?” I would not just ask questions, but do what all parents should do: get to know my child, and provide a setting where they are comfortable talking openly and being themselves. I would show that I am safe to talk to.

Too many young people who are gay or gender non-conforming, especially those in conservative families and communities, live in fear that being open about who they are will bring about abuse, alienation, ridicule, or worse. Trans people are disproportionately more likely to end up homeless, out of a job, and alienated from former friends and family than cis people, and the prevention of those consequences starts at home.

I would also extensively review all the peer-reviewed literature on the type of behavior the child is exhibiting and get the professional opinions of multiple mental health professionals before agreeing to any form of treatment. If, at that point, it can be demonstrated that this child is someone who, irrespective of anything I say or do, would choose to transition as an adult and live the rest of their life as a woman, I would approve of puberty blockers because to not do so would be a detriment to their wellbeing.

If the evidence shows this person’s long-term prospects for wellbeing are better taking puberty blockers, only then would I sign off on them. It is essential to understand that by denying a gender dysphoric person puberty blockers, you are forcing them to go through a puberty that will make their body less like the one their internal psychology tells them they should have and likely worsen their mental health and increase their suicidality. It should not be hard to understand why someone whose well being is tied to presenting as feminine would be undermined by going through a male puberty, and vice versa for someone wanting to present as masculine, being forced to go through a female puberty. Furthermore, for the state to do so would be government-imposed harm on the individual that goes against personal freedom and the findings of the relevant medical research.

I’ll take this opportunity to point out that A 2020 review in Child and Adolescent Mental Health found puberty blockers were associated with such “positive outcomes as decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life.”

Also, a 2020 survey published in Pediatrics found that “There is a significant inverse association between treatment with pubertal suppression during adolescence and lifetime suicidal ideation among transgender adults who ever wanted this treatment.”

2022 study published in the Journal of the American Medical Association found “a recipient of gender-affirming care, including puberty blockers and gender-affirming hormones, was associated with 60% lower odds of moderate or severe depression and 73% lower odds of suicidality over a 12-month follow-up.”

Likewise, for the use of doctor-prescribed cross-sex hormones, as noted in a 2022 study from the Journal of Adolescent Health, which found “use of (gender-affirming hormone therapy) GAHT was associated with lower odds of recent depression and seriously considering suicide compared to those who wanted GAHT but did not receive it. For youth under age 18, GAHT was associated with lower odds of recent depression and of a past-year suicide attempt.”

At this point in the conversation, I’ll then get asked about the surgery. Would I be “totally fine” with my child’s genitals being surgically modified? So often, the phrases “cut off” or “mutilated” get thrown around,” and often, it is suggested that this would happen at some prosperously young age.

Genital surgery, as a treatment for gender dysphoria, usually is done on people 18 or older, making this a mostly unrealistic strawman. That said, the more extreme the medical intervention proposed, and the younger the person receiving it, the greater the burden of proof that would need to be met by the person proposing it for me to approve it.

I was once asked in this context: “You don’t have one single issue with it, and you would 1000% encourage ALL of it?” I answered: “No, I’m not 1000% or even one 100% ok with ALL of it. In fact, it all makes me rather uncomfortable. Still, I would pursue whatever action is supported by the empirical evidence rather than simply follow my emotions.”

I think there is room for honest debate on how much medical gatekeeping is appropriate for trans care, especially at younger ages. But the absolutist opposition I see from social conservatives is not what that debate looks like.

Honest debate involves knowing what you are talking about, acknowledging where you lack expertise, acknowledging you may be wrong about a given point, and acknowledging points and concerns made by the other side. It involves knowing what the peer reviewed research says, and being familiar with such topics as standards of diagnosis, and eligibility for treatment.  It should primarily be done by people with the appropriate medical backgrounds, and not by politicians, professional outrage peddlers, culture warriors and grievance merchants.

Despite the picture rightwing media outlets paint, studies on the topic actually tend to find positive results from gender-affirming surgery. For example, this 2021 study from Havard researchers that found gender-affirming surgery reduces psychological distress and suicidal ideation and even decreases smoking.

That said, I would not simply encourage any suggestion that gets thrown out either: I would question, gainsay, play devil’s advocate, explore other options, and get second, third, fourth, and fifth opinions at every step of the process. I’d likely toss and turn all night, wondering if I was handling the situation appropriately. The whole thing would be immensely stressful to me. What I would not do, though, is simply dismiss out of hand what my child is experiencing, nor would I try to force gender conformity on my child, as I’ve seen many social conservatives say they would do and as numerous people have done, likely with tragic results.

Conservative culture warriors are determined to demonize trans people, as a means of driving engagement from their base. In response Republican politicians have been aggressively putting forward and passing hundreds of anti-trans bills throughout the United States. These bills will increase human misery, depression, and suicidality. Also, the rhetoric that goes with them will likely encourage acts of violence against gender non-conforming people. All their supporting arguments involve mischaracterizing the evidence, retreats to conspiracism, and fallacious appeals to emotion and outrage. But, I guess that is to be expected of reactionary, authoritarian statists, which social conservatives have always been. 

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