New York Times Magazine publishes seminal article on trans issues

An article in the New York Times Magazine takes a serious look at the battlegrounds that mark childhood trans issues in America today.

In short, it’s a mess.

On one end of the spectrum are right-wing kooks who want to erase trans people and issues from American culture.

On the opposite are many trans “true believers,” radicals who say that any child at any stage of development should be the sole arbiter of how their trans journey unfolds.

Caught in the middle are many trans-competent clinicians and researchers who say that trans kids should receive the best, most sensitive care possible within, as much as is currently possible, science-based research and treatment plans.

In 2011, de Vries and her colleagues published the first of two landmark studies about medical interventions in adolescence. Among the first 70 patients who received puberty suppressants at the Amsterdam clinic after their initial assessment at the mean age of about 13½, the researchers found “a significant decrease in behavioral and emotional problems over time.” A second study published in the journal Pediatrics in 2014, of about 55 of those who went from puberty suppressants to hormone treatments at the mean age of about 16½, showed that five years after starting hormone treatments and at least one year after surgery, they had the same or better levels of well-being as a control group of cisgender adults their age. None of the 55 regretted their treatment. (The 15 of the original 70 who were not included in the follow-up study did not take part mainly because of the timing of their surgery.)

For the first time, a long-term, peer-reviewed study showed positive outcomes after medical treatment in adolescent patients who’d gone through Cohen-Kettenis and Delemarre-van de Waal’s protocol. They had all been through a version of the type of assessment the December draft of the SOC8 adolescent chapter would recommend years later. They had experienced gender dysphoria since childhood (according to their families), lived in supportive environments and had no interfering mental-health conditions. As is often the case in medicine, the question for those drafting the SOC8 would be how to apply the findings of a particular cohort to the growing numbers of teenagers lining up at clinics in a host of countries.

In the United States and Canada, meanwhile, two dueling approaches to therapy for young children, before they reached puberty, were vying for supremacy. At what is now called the Child and Adolescent Gender Center at the University of California, San Francisco, Diane Ehrensaft, a developmental and clinical psychologist, was counseling families to take what she and others called a “gender affirming” approach, which included a social transition: adopting a new name and pronouns for a child who expressed such a preference, along with letting kids dress and play as they pleased.

For years, Ehrensaft’s intellectual foil was Ken Zucker, a psychologist and prominent researcher who directed a gender clinic in Toronto. Between 1975 and 2009, Zucker’s research showed that most young children who came to his clinic stopped identifying as another gender as they got older. Many of them would go on to come out as gay or lesbian or bisexual, suggesting previous discomfort with their sexuality, or lack of acceptance, for them or their families. Based on this research, in some cases Zucker advised parents to box up the dolls or princess dresses, so a child who was being raised as a boy (a majority then) wouldn’t have those things to play with.

It’s a great article, but it’s hard to know who’s correct at this point because data is relatively scarce and because the treatment outcomes for trans children’s care involve self-reported feelings by patients and parents about their mental health and general well-being.

There are currently no biomarkers or other measurable physical differences which marks someone as trans. As opposed to, say, the treatment of an infection, which has endpoints that are easily verifiable, including no longer detectable pathogens, normal body temperature, etc. (That is not to say that being trans is a disease. Only that measuring the effects of short- or long-term treatment plans can be wobbly.)

Without large-scale, reproducible peer-reviewed research, there is a void in concrete knowledge that has created a vacuum into which activists on the far right and the far left have inserted themselves and created clinical and political chaos.

Nonetheless, I came away from reading this article knowing many things I did not know before, along with the usual confusion about whose information to trust as what is in the interest of trans kids overall.

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