Editor’s note: This is a response to the piece written by Keith Jordan. Samantha Lee requested to remain anonymous and decided to use a pen name.
The medical care of transgender adolescents has become a flashpoint for ideological battles in recent years. Certain commentators and groups have put forth misleading narratives about transgender youth, disregarding clinical evidence to raise unfounded concerns about imaginary harms.
These bad faith arguments typically claim transgender identities in youth are a social contagion, dismiss gender dysphoria as pretend distress, and allege activists are manipulating “susceptible” children into mistaken transgender identities – while advocating against best practice medical guidelines.
In reality, extensive research confirms gender dysphoria is a serious condition tied to intense distress in transgender individuals. Gender dysphoria is recognised by all major medical associations as a legitimate diagnosis.
Studies show most transgender youth exhibit early signs of incongruence between their assigned sex and experienced gender, disputing claims this is a “rapid onset” phenomenon. Gender incongruence persists from a young age in a majority of trans adults looking back on their childhood experiences.
The most robust longitudinal studies make clear that transgender identities are not a social fad. Trans youth do not take on these identities lightly or without legitimate cause. There is no credible evidence of nefarious influences pressuring kids into false transgender identities.
While the causes of gender incongruence are still being investigated, biological factors are known to play a key role. Even small children, raised without external influences, exhibit strong preferences and behaviours typical of their gender identity rather than assigned sex. This strongly points to innate biological underpinnings, not fabricated social identities. A 2016 review demonstrates biological and innate factors contribute significantly to gender identity and incongruence.
Some try to conflate gender incongruence with body dysmorphia, but decades of research reveal key differences. Gender dysphoria correlates strongly with physical aspects of one’s assigned sex at birth, while body dysmorphia focuses on dissatisfaction with specific body parts. Trans individuals, if given access to care, can live happy and fulfilled lives in their experienced gender.
A common refrain is that transgender identity is an ideological invention pushed by “activists” onto youth. But transgender people have existed across history and cultures. The only new development is our evolved understanding as clinical research brings facts to light.
When it comes to the specific needs of transgender youth, the ideological attacks become even more concerning. Transgender adolescents face distinct challenges as they navigate gender identity development amid rapid physical and social changes. They require evidence-based, developmentally appropriate care to address gender dysphoria at this sensitive time.
Denying best-practice medical care and social support until adulthood causes needless suffering for transgender youth and their families. The ethics around childhood transition are complex, but a measured approach recognises that allowing age-appropriate changes like social transition and puberty blockers can substantially reduce the risks of depression and suicide.
Rhetoric rejecting this care for ideological reasons shows no compassion for the well-being of trans youth in crisis. We must stand up to such misinformation and ensure care decisions are guided by factual data and the input of adolescents, families, and healthcare experts.
Some argue that treatment for adolescent gender dysphoria should be delayed until adulthood. But this ignores copious data on the serious risks faced by transgender youth unable to access care.
Robust studies make clear that letting trans adolescents socially transition and access puberty blockers to delay body changes reduces depression, suicidal ideation, and self-harm to levels consistent with the general population. Withholding medical care until adulthood causes needless suffering.
Detransition after medical transition is also exceptionally rare, undermining those who cite this as a key danger. Large observational studies find only 0.3–0.6% of transgender patients detransition after gender-affirming surgery, mostly due to social pressures or loss of family support rather than transition regrets. This compares with general surgery regret rates up to 20 times higher for other common procedures.
Rather than give credence to manufactured controversies over transgender youth, decisions on appropriate care should be guided by scientific evidence and input from the adolescent, parents, and doctors – not ideologically-biased assumptions. The American Academy of Pediatrics policy statement provides an example of professional guidelines from a reputable medical organisation that could be cited as recommending an evidence-based, patient-centred approach to transgender youth care.
Further research to understand the roots of gender incongruence is valuable and necessary. But current evidence provides a clear framework for supporting transgender adolescents with compassionate, developmentally appropriate, individualised care based on their specific clinical needs.
With respect for evidence over conjecture, we can focus the discussion on ensuring the well-being of all youth struggling with gender diversity issues and foster an environment where they can thrive.
Samantha Lee is a writer and advocate focused on LGBTQ youth issues.