In recent days, two of my colleagues here at The Libertarian Republic have expressed dissenting views on the controversial video of a mother providing her young son with estrogen patches in his quest to transition from boy to girl. While R. Brownell takes the position that such an act is akin to “child abuse”, Micah J. Fleck argues gender dysphoria is a real condition that deserves empathy and understanding. While a third piece on the subject may seem excessive, it’s important to hear the voices of biological women when addressing the subject of male-to-female transition, as well as touching on specific aspects of gender dysphoria not discussed by Fleck.

In his article, Fleck writes that to qualify for a diagnosis of gender dysphoria, one must fit a specific list of criteria and be evaluated by a psychiatrist before beginning the process of sex reassignment. While true, psychiatric evaluations are inherently flawed, and despite being given the go-ahead, children can too often come to question their decision. Fleck himself notes, “popularity is not indicative of correctness”, and I’m inclined to concur; the popularity of sex reassignment does not indicate it to be the correct course of action. Consider this letter, authored by the president, vice president, and psychiatric consultant to the American College of Pediatricians (ACP), in response to an article published in Pediatrics aiming to normalize gender dysphoria:

We vigorously object to the normalization of childhood gender identity disorder (GID) promoted by the American Academy of Pediatrics (AAP) […] The recommendations of the authors to reinforce the delusions of gender identity–confused children, and to prescribe puberty-blocking hormones as though puberty were a disorder, are outrageous. This approach violates the oath physicians take to ‘do no harm’“.

It’s well known throughout the medical community that children’s brains do not reach peak maturity until they reach their early 20’s, while their bodies don’t typically reach full maturity until their late teens. To provide young children who cannot make proper adult decisions, then, with adult doses of opposite-sex hormones, thereby setting them up for a lifetime of medical supervision and painful procedures, contributes to the mental health issues and suicide rates of post-operative patients:

A recent 30-year study in transgendered adults in Sweden, unquestionably a transgenderaffirming culture, should give the AAP and American Psychiatric Association (APA) pause: it showed that individuals who underwent sex reassignment surgery suffered significantly greater morbidity and mortality when compared with matched controls. Shockingly, their suicide mortality rose almost 20-fold above the comparable nontransgender population. The authors concluded, ‘Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism’“.

If suicide rates among transitioned individuals are so high, why does society perpetuate the idea that sex-reassignment will somehow “cure” the condition? Why are people unhappy post-transition if they’re finally who they were born to be?

Proponents of sex reassignment therapy and surgery often lament that children are, in fact, capable of recognizing their own gender dysphoria, contesting the view that such children are confused. Is an 11-year-old, the age at which the boy in the above video began to “transition”, more likely to have a firm handle on who he really is or be confused by his mother’s pressure after he wanted to wear pink? His mother says he was always feminine as a child; I was always masculine but by mid-teens I had completely grown out of it and am now a proud, feminine woman.

According to the National Center on the Sexual Behaviour of Youth, preschool children often play and dress up as the opposite sex as part of their sexual development. Is it a stretch to question whether or not parents are interpreting normal childhood development as gender dysphoria and accidentally planting false notions in their children’s minds? Fleck writes, “the fact that some gender role-defying behavior in kids is not indicative of gender dysphoria does not mean that we are somehow unable to tell the difference under closer investigation”. Is he sure?

Fleck points to a study of transgender children whose findings conclude the “gender identity of these children is deeply held and is not the result of confusion about gender identity or pretense”. This woman doesn’t seem confused about her eyesight, however, and suffers from body integrity identity disorder (BIID), a mental health issue in which patients feel their “idea of how they should look does not match their actual physical form”. To be consistent with supporting sex reassignment, one must also support healthy amputation and outright mutilation in BIID patients. While some might argue BIID is a mental illness, gender dysphoria is included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the master collection of known mental health issues used by mental health professionals, and studies have demonstrated a significant percentage of gender dysphoria patients suffer from cooccurring psychiatric disorders (emphasis mine):

Cooccurring psychiatric disorders influence the outcome and prognosis of gender dysphoria […] Eighty-three patients requesting sex reassignment surgery (SRS) were recruited and assessed […] Fifty-seven (62.7%) patients had at least one psychiatric comorbidity. Major depressive disorder (33.7%), specific phobia (20.5%), and adjustment disorder (15.7%) were the three most prevalent disorders […] Consistent with most earlier researches, the majority of patients with gender dysphoria had psychiatric Axis I comorbidity”.

Is it unconscionable to question the gender identity of these people after receiving treatment for existing mental illness? And while proponents say hormone therapy is safe, the ACP concludes there is,

…no adequate body of research on the long-term use of puberty blockers in early adolescence followed by lifelong administration of exogenous testosterone to biological girls or of exogenous estrogen to biological boys. However, there is significant evidence indicating stunted growth and infertility from puberty-blocking hormones, and possible malignancies from chronic use of synthetic hormones“.

Is it child abuse to acquiesce your son or daughter’s request to begin taking synthetic sex hormones? I don’t think so. Parents generally want what’s best for their children, and I don’t believe parents of children with gender dysphoria are actively looking to do harm when they provide them with synthetic hormones or encourage them to continue playing with dolls or trucks.

I do believe, however, while I certainly cannot speak for men, that it’s offensive and insulting to reduce womanhood, and what it means to be a woman, to estrogen patches, makeup, and breast implants. Biologically, women are born with the ability to reproduce, meaning we possess female reproductive organs which shape many of our experiences in life. Such experiences, ranging from first periods to pregnancy (or in some cases, infertility) to menopause can never be shared by a man, regardless of how much of a woman he may believe himself to be. Social experiences, such as frequent sexual harassment and day-to-day interactions with the world around us, greatly differ from the experiences of men. The idea that men can put on a wig and call themselves women spits in the face of feminism, which fought so hard to define women as unique from their male counterparts. Unfortunately, the prevailing attitude nowadays is one of, ‘if you decide you’re a boy, you’re a boy, and if you decide you’re a girl, you’re a girl; biology be damned’.

Elinor Burkett, writing in the New York Times, puts it best:

I have fought for many of my 68 years against efforts to put women – our brains, our hearts, our bodies, even our moods – into tidy boxes, to reduce us to hoary stereotypes. Suddenly […] many of the people I think of as being on my side – people who proudly call themselves progressive and fervently support the human need for self-determination – are buying into the notion that minor differences in male and female brains lead to major forks in the road and that some sort of gendered destiny is encoded in us. That’s the kind of nonsense that was used to repress women for centuries. But the desire to support people like Ms. Jenner […] has strangely and unwittingly brought it back“.

This desire, for all the positive intentions born of it, erases the core experiences of womanhood. Fleck says genitalia has “nothing to do” with sex-reassignment therapy and often becomes the focus of dissenting arguments, but biology and social experiences do have something to do with what constitutes “male” and “female”. Arguably, the feelings of biological women who believe, as Ms. Burkett does, that “[trans] female identities are not my female identity”, are largely ignored, sometimes eviscerated, despite their sincerity.

Ultimately, gender dysphoria is not a cut-and-dried issue. There are many scientific and ethical questions, particularly pertaining to children, that create nuances too complicated to fully explore in one piece. The debate surrounding sex reassignment is a heated one, often drawing out the worst of folks on both sides, which prevents rational, intellectual discussions from occurring. What I have presented here is but one take on a contentious issue, and while I fully expect backlash, I hope productivity trumps ad-hominem attacks and opens the door for civilized conversation.