Transgender identity is a much louder topic in the media recently. We are seeing stories in major newspapers about nonbinary young adults coming out and taking on the world, we’re reading about the discrimination that trans people face, and in the past week or so in particular we are hearing about transgender children.
Yesterday Woman’s Hour on BBC Radio 4 hosted a “debate” about whether medical treatment for children who are transgender is appropriate. It was in many ways intentionally misinforming and harmful, and things have been said by CN Lester on Twitter and in a blog post on that subject I’m going to talk about that debate here; for some context, here’s the programme on iPlayer, and here’s the transcript.
This debate made many common mistakes that I would like to make very clear now.
Transgender people, including children, are not just people rejecting gender norms and gender roles. The BBC and radical feminist Mackay seemed to be assuming that trans kids are just boys who want to wear pink and girls who want to wear dungarees. The presenter literally said that in the introduction. When you take away gender roles and gendered language and gendered power imbalance, what’s left is who we are - and we are not all agender. In a society where nothing is gendered at all, not even pronouns, people with what we currently call “gender dysphoria” will still exist because it may look different and feel different but gender will probably still exist.
An uncomfortable condition entirely created by society should still be treated medically to the best of everyone’s ability. Mackay argued during the Woman’s Hour debate that blame for trans identities lies not with nature but with society’s imposing of strict gender norms on young children. This was framed in opposition to Bridgman’s view as a psychologist that many trans children need medical treatment. Regardless of the cause of any discomfort, refraining from treating a condition in the most effective way possible is deeply unethical. To do so for political reasons is harmfully selfish.
Puberty blockers are not permanent and irreversible. They slow puberty to give trans children time to consider their identity and how they fit into the world. When the child is ready, the most suitable puberty can continue unaffected.
Puberty blockers are not easily prescribed. You can’t just walk into a clinic for the first time and say “my child is/might be transgender” and walk out with puberty blockers. A child must live in-role for a minimum amount of time (usually at least a year), and have the full support of the parent(s) and/or guardian(s). Doctors here in the UK are very reluctant to prescribe hormonal drugs to minors, and it’s only done in severe cases.
Puberty blockers save lives. Transgender children have much higher rates of self-harm and suicide attempts, many of which are successful. Puberty for transgender people is traumatic, and the trauma doesn’t go away. It’s like being slowly crushed by a steamroller for 5 years, and being surrounded by trusted friends and family telling you you’ll get used to it, everyone feels this way, etc.
Puberty blockers save money. Top surgery costs the NHS about £6,000, carries all the expected risks, can lead to loss of chest sensation, and is preventable with blockers. The voice dropping is permanent, and voice therapy is specialist, insufficiently available, and expensive - also preventable with blockers. Laser treatment for facial hair costs thousands of pounds and takes many painful sessions over a long period of time - also preventable with blockers. Gendered bone structure is permanent and irreversible - and preventable with blockers. Some surgeries, like genital and reproductive surgeries, cannot be prevented with blockers - but a lot of other things can.
But this is not a debate about the practical or the effective.
When we are trans children, people say we are too young to know for sure; when we are trans teens, people say we’re just going through a phase; when we are trans adults, people say we can’t be unless we were stereotypically trans when we were children.
This is a message from a society that does not believe we have a right to the treatment we need. We are required to live through irreversible hell to deserve treatment (unlike any other condition), which must be approved by people who do not fully understand us. When we have done everything we can to live authentically we stand before a panel of judges and pay for the privilege of being told whether they think we are who we know we are.
This must change.