Kersten: Put children’s safety ahead of ideology
This op-ed appeared July 18, 2017 in the St. Paul Pioneer Press.
The number of children who report being unhappy with their biological sex has exploded in the last 10 years. Parents, school officials and public leaders are all deliberating about how to deal with the challenging issues raised by kids who say they wish to live as the opposite sex — who think of themselves as transgender.
So far, the focus has been on “rights-based” disputes — which bathrooms and locker rooms students should use at school, for example. But the question goes deeper.
One thing is clear: The goal of all involved should be to minimize young people’s suffering and promote their best interests, laying a foundation for them to become happy, healthy adults.
The Minnesota Department of Education (MDE) has laid out its position in a document entitled “Toolkit for Ensuring Safe and Supportive Schools for Transgender and Gender Nonconforming Students”. The MDE will distribute the toolkit to K-12 school superintendents and charter school leaders if a council approves it July 19.
The DOE maintains that its over-arching goal is to ensure that “transgender and gender nonconforming” children are “safe”, both at school and at home. To ensure safety, the agency says, schools and parents must “support” and affirm a child’s expressed “gender identity”. That means students must be free to choose whatever bathrooms, athletic teams, etc., align with that identity.
But is affirming an 8- or 14 year-old’s personal perception — whatever it may be — really best for their health and well-being? If we care about kids, we must ask the tough questions that social and political pressure are increasingly taking off the table.
Here’s a vital fact you won’t find in MDE’s toolkit: The great majority of children with “gender dysphoria” — who are distressed about their biological sex — outgrow this condition after passing through normal puberty, according to the American Psychiatric Association’s fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. That’s why the traditional treatment has been “watchful waiting” and family therapy to address the psycho-social issues that may contribute to this condition.
But in 2007, Dr. Norman Spack of Boston Children’s Hospital introduced a new protocol, developed in the Netherlands. Under this radically different, “affirming” approach, gender dysphoric children are given puberty blockers at around age 12 and cross-sex hormones (estrogen for boys, testosterone for girls) at age 16 or so. Surgery may follow, including double mastectomies for girls as early as age 16 and genital surgery as early as age 18 or before.
The “Dutch protocol” carries many medical risks. Puberty blockers stunt growth during use, and there is evidence they can decrease bone density, according to “Growing Pains: Problems with Puberty Suppression in Treating Gender Dysphoria,” a 2017 report by three prominent physicians — Paul Hruz, Lawrence Mayer, and Paul McHugh.
Lifelong sterility is likely when puberty blockers are followed by cross-sex hormones. In addition, cross-sex hormone use can increase the risk of cancer, liver disease, diabetes, stroke and heart attack, according to the Transgender Health Program of Vancouver, Canada.
In fact, there is very little medical research on the long-term effects of hormone use in the context of gender transition. The effects on children’s brain development, for example, are unknown. Fenway Health, an LGBT medical facility in Boston, warns that “the long term effects” of testosterone use by females and estrogen use by males have “not been scientifically studied and are impossible to predict.”
We do know that cross-sex hormone use entails lifelong dependence on the medical system. Many of the secondary sex characteristics that hormones stimulate disappear when they are discontinued, though others — such as male-pattern baldness in females and breast growth in men — are irreversible.
Are young people capable of giving informed consent to such risky treatments — likely to cause permanent infertility, for example — at an age when many states bar them from using a tanning bed or getting a tattoo?
One group at particular risk is children on the autism spectrum of brain disorders. These youngsters, who often have impaired self- and social-awareness, are seven times more likely than their peers to report gender dysphoria, according to research.
MDE justifies its proposed school policies on grounds that affirming gender-dysphoric children’s self-perceptions is imperative for their safety. Yet how is it “safe” to encourage children to make irreversible, life-transforming decisions on a matter that is poorly understood by medical professionals, and to do so when an immature brain makes informed consent impossible?
Parents and young people are well-advised to proceed with caution on gender transition, and to follow the traditional course of “watchful waiting” and family therapy. After all, we would not — as a matter of policy — “affirm” anorexic children, who “consistently and persistently” view themselves as obese when they are in fact dangerously thin. Rather, we work to get them the help they need.
Yet MDE’s transgender toolkit implies that parents who do not affirm their child’s self-perception as transgender to school officials’ satisfaction may be reported to government officials for “child neglect or harm”.
Advocates often assert that gender-dysphoric children who are not affirmed in childhood are at heightened risk of suicide. Yet in the great majority of youngsters, this condition resolves naturally after puberty. Tragically, individuals who have sex-transition surgery have a suicide rate almost 20 times greater than the general population, according to a major study. Transition does not ensure safety.
Unfortunately, advocates of the “affirming” protocol have succeeded in framing gender dysphoria, a complex psycho-social condition, in terms of a civil rights narrative. We owe it to young people who face this traumatic dilemma to put their safety — not ideology — first.
Katherine Kersten is a senior policy fellow at the Center of the American Experiment, a Minneapolis-based non-profit public policy organization.