The appropriate medical care of transgender adolescents has emerged as a complex issue clouded by ideological biases on both sides. While the distress experienced by gender dysphoric youth is real, claims of rampant social contagion lack rigorous evidence. Meanwhile, calls to ban medical interventions must contend with data showing benefits in some cases. Navigating this landscape demands nuance, compassion, and letting evidence guide decisions.
Advocates for restrictions cite the rapid increase in adolescents, mainly girls, newly identifying as transgender as proof of a harmful social trend. Estimates suggest the rates of youth identifying as trans or non-binary have increased by over 300% in the last decade, with nearly 2% of US high school students identifying as transgender. But while the rising prevalence is concerning, few long-term studies exist to substantiate causes. Plausible factors like increased social acceptance or emulation of peers have unproven influence. Just as a lack of evidence prevents declaring this a contagion, claims that restrictive approaches prevent imaginary harms must rely more on ideology than available data.
At the same time, many advocating for affirming care downplay legitimate uncertainties. Though some brain scans and twin studies suggest biological roots to gender dysphoria, research into origins and persistence remains sparse, especially for adolescents. The few longitudinal studies focused on transgender youth tend to have small sample sizes and limited follow-up periods under 10 years. While transgender identities are unlikely to be mere fads, more research is needed before declaring them innate and immutable.
There is also the truth that dysphoric distress can be exaggerated when affirmation is seen as the sole path to medical treatment. Strict intake processes are thus reasonable to avoid enabling manipulation. But again, evidence is lacking on the scale of this problem. A balanced view recognises dysphoria’s seriousness for many but remains open to needed research on its onset and causes.
With origins unclear, selecting appropriate treatment relies heavily on outcome data. Here again, extremist stances on both sides prove unhelpful. Detransition after gender-affirming surgery is indeed very rare, suggesting the benefits outweigh the inherent risks of irreversible treatment for many patients. A 2021 study of over 27,000 patients in Sweden who underwent gender-affirming surgeries found regrets requiring detransition were extremely rare at around 0.3–0.6%
But limited long-term studies, specifically in adolescents, make widespread declarations about universal best practices premature. Data on the long-term impacts of puberty blockers and hormones initiated during youth is especially sparse. While some studies show benefits like reduced depression, others raise concerns about potential effects on bone health, fertility, and social development that require further research.
Likewise, while social transitions and puberty blockers show benefits in reducing suicidal ideation, studies focused on long-term psychological and physical impacts are sparse. Knee-jerk comparisons to obviously harmful practices like conversion therapy are unconstructive. In reality, ethics are complex, situational, and require nuance rather than absolutism.
US states have taken a range of approaches to this issue, from restrictive bans on gender-affirming care for minors to more permissive policies granting adolescents autonomy over medical decisions. But political ideologies often override credible data in crafting these policies. Several states’ attempted bans have faced injunctions amid lawsuits from advocacy groups. The heated legal and ethical debates will likely persist without definitive research. On the other hand, states like California, Colorado, Connecticut, Illinois, Maine, Maryland, Massachusetts, Nevada, New Jersey, New York, Oregon, Rhode Island, Vermont, and Washington have laws/policies explicitly allowing minors to access gender-affirming medical care.
When it comes to supporting transgender youth, it can be tricky to balance different perspectives. The youth are still figuring themselves out. Parents might disagree on the best approach. Doctors have professional responsibilities and legal worries. Schools want to accommodate everyone. It’s tough to find solutions that make a young person feel heard while respecting parents’ concerns and experts’ advice. But open and patient communication between the youth, family, doctors, and school is important to work through the nuances together.
True centrism means resisting pressure from activists on both sides. It requires acknowledging where ideology risks overriding compassion and facts. We must recognise that politicised societal narratives likely influence some youths’ self-perception of gender incongruence. But we must also see their distress as real and deserving of support.
The needs of gender-dysphoric youth are complex. Research into long-term outcomes is clearly needed to better guide treatment. In the interim, nuance and moderation are vital.
With compassion for struggling youth, we can resist extremism and ensure care decisions are guided by facts and a collaborative weighing of benefits against risks. If we avoid hardened stances that ignore uncertainties, balanced solutions are possible. But they demand open and rigorous minds on all sides.
Miles Fletcher is a writer based in Los Angeles, California examining issues of medicine and ideology. He works to bring nuance to complex and politically-charged topics.
