Primum Non Nocere

"Gender-affirming care" is the new lobotomy.

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“Primum non nocere” is the Latin phrase for “first, do no harm,” and is an admonition to physicians to seriously consider the risks of any treatment before applying it. “Gender-affirming care,” a euphemism for the process whereby clinics immediately affirm children who claim transgender identities and put them on a path to permanent medicalization and self-harm, is in direct conflict with this.

As recently as 2012, the Washington Post reported that there was very little scientific research supporting the “transitioning of children,” and that “the very idea of labeling children as transgender is shocking to many people.” Eleven years later there’s still very little to go on scientifically in support of transitioning children,¹ yet it has gone mainstream thanks in large part to an alliance consisting of NGO lobbies, Democratic politicians, and a scientific clerisy with activist commitments—Good People™ all, to be sure.

Adolescents are different from adults in vital ways. It’s common sense, and we recognize this in every facet of life except when it comes to our “transgender moment” and its treatment prescriptions. Activists are telling parents that puberty blockers, cross-sex hormones,² and permanent disfigurement may be the only way to prevent their children from committing suicide. Never mind that the vast majority of children with gender dysphoria — 80 to 95 percent — naturally grow out of it, if they’re not encouraged to transition. And never mind that people who’ve had transition surgery are nineteen times more likely than average to die by suicide.

One of the key claims underlying gender-affirming care is that blocking puberty is a cautious and prudent measure that affords a child the time to “explore” his or her gender identity “without the distress of developing secondary sex characteristics.” But in reality it’s a drastic and experimental measure with a host of serious side effects that can do irreparable harm to a child. Even the FDA has warned that puberty blockers can cause brain swelling and vision loss in children, while the United Kingdom’s leading facility for treating gender-dysphoric children found that bone density and normal growth flatlines and psychological well-being doesn’t improve. As Jesse Singal has detailed, “Western countries keep conducting careful reviews of the evidence for puberty blockers and hormones, and they keep finding that there is very little such evidence to speak of.”³

This is a detransitioner who was put on Lupron. Once used in the chemical castration of sex offenders, Lupron is the go-to puberty blocker given to transgender youth.

All of the major activist groups, and many professional groups, perpetuate the claim that puberty suppression is reversible. This is patently ridiculous. Virtually every part of the body undergoes significant development in sex-specific ways during puberty, and going through the process at age eighteen can’t reverse ten years of blocking it. When it comes to developmental biology, there’s a normal sequence in which many things happen as the body matures, and when some things happen out of phase, the developmental process isn’t normal. As Ryan Anderson explains in When Harry Met Sally, allowing the developmental sequence to proceed without interruption is important not just for physical maturation, but also for psychological and neurochemical reasons.⁴

How this process happens isn’t well understood, so it’s imperative to be cautious about interfering with it. But far from being cautious by using puberty blockers on children, doctors are essentially conducting a giant experiment that doesn’t come close to the ethical standards demanded in other areas of medicine. Indeed, in all other areas of medicine, experimental procedures must be overseen by a review board. Gender-affirming care involves no such oversight. Moreover, when we allow parents to consent to medical procedures for adolescents, it’s typically to permit doctors to save, cure, or alleviate an observable medical problem. But in the singular instance of transgender medicine, we allow a parent to consent to intervention that essentially introduces the “disease state” brought on by a pituitary tumor—all based on self-reported mental distress by the child.⁵

Dr. Michelle Cretella argues that putting an adolescent on a path of social transition and pubertal suppression is a “self-fulfilling” protocol, as it sets the child on a course with its own momentum, each step reinforcing a trajectory that leads to irreversible outcomes. Citing what science now knows about neuroplasticity, she notes that for a boy with gender dysphoria “the repeated behavior of impersonating a girl alters the structure and function of the boy’s brain in some way—potentially in a way that will make identity alignment with his biological sex less likely,” and thus increasing the likelihood that further transitioning steps will be taken. In addition to this behavioral effect, the medical suppression of puberty “prevents further endogenous masculinization of his brain,” so that he remains “a gender non-conforming prepubertal boy disguised as a prepubertal girl.” And while this is happening, the boy’s peers are developing normally, so he’s even more isolated and less able to identify as male.

Researchers have found that a young child’s “gender identity” is both “elastic” and “plastic.” It can change over time, and it responds to outside forces, including messages received from the broader culture—and the approval or disapproval of parents.

Speaking of parents, it seems pretty clear that for a certain segment of affluent white progressives, having a trans child is a status symbol. Unlike lower income families, they have the time and money for such things. And because Critical Theory has conditioned them to believe that they’re oppressors with no hope of escaping that label, they see transing their children as a way to join an oppressed class for which they’re celebrated instead of condemned. The list of woke celebrities who’ve transed their sons and daughters continues to grow.

Naomi Watts, Charlie Theron, and Megan Fox have all transed their kids. Theron has two adopted sons who she says are girls. Fox has three sons, all of whom she says are girls. One study found that approximately half of the mothers of boys with gender dysphoria had two or more diagnoses of a mental disorder, and about one-quarter had at least three such diagnoses. Seems relevant.

A transgender kindergartener is like a vegan cat. We all know who’s making the choices.

It’s easy to see how parents may come to play a role in discouraging desistance. The more credulous often become “champions” of their child’s transgender identity to teachers and other parents, and advocates for transgender ideology more generally. This can obviously have a solidifying effect for the child, affecting their sense of self. If the dysphoria begins to fade, the child then faces a dilemma: either persisting with a gender identity that no longer feels like it fits, or telling their parents that the life they’ve helped create and which they’ve advocated for was a mistake. And of course teachers, friends, and relatives who’ve become involved in the transitioning process will need to reverse course as well if the child detransitions.

In this way, the gender-affirming care nonsense limits a child’s future options because of the social or familial costs of transitioning back, causing some children to persist in a transgender identity when they would otherwise have grown to accept their natal sex. Those children then go on to permanently harm themselves.

In the last decade adolescent gender dysphoria has surged across the West. In the U.S., the prevalence has increased by over 1,000%.⁶ In Britain, the increase is 4,000%, and three-quarters of those referred for gender treatment are girls. Given these extraordinary figures, as well as the abrupt shift in demographics — from majority boys with a history of childhood gender dysphoria to majority adolescent girls with no such history — you’d think that the people encouraging minors to undergo gender-affirming care would pump the breaks and exercise more caution. But you’d be wrong.

An adolescent’s brain is too immature to make reliably rational decisions. That’s what neuroscientists say. But we’re supposed to go along with the idea that impressionable and confused children can make decisions about their gender identities and serious medical treatments. It’s absurd. Gender-affirming care flies in the face of reality, which is that a child or adolescent in distress is rarely reducible to one problem. Other psychosocial issues usually underlie their false assumptions.

Until a 2015 controversy cost him his job,⁷ Dr. Kenneth Zucker was universally recognized as an international expert on child and adolescent gender dysphoria. As psychologist-in-chief at Toronto’s Centre for Addiction and Mental Health, he spent decades conducting research and practicing what he was trained to do—help young people with gender dysphoria grow more comfortable in their bodies. His philosophy was simple: A narrow and exclusive focus on gender as the source of distress often misses the broader picture of a troubled inner life. To reach an accurate diagnosis, Zucker believes mental health professionals need to look at the whole child.

He was amazingly successful with this approach. Zucker’s colleague Devita Singh reviewed the outcomes in the cases of more than one hundred boys who’d been seen by Zucker at his clinic. In cases in which a child hadn’t been socially transitioned by parents, she found that 88% outgrew their gender dysphoria. In the case of one child he treated, the boy’s desire to be a girl stemmed from wanting to connect with his single mother, who had briefly abandoned him and “seemed to transfer much of her psychological investment to his sister.” The therapy addressed his feelings of abandonment and only secondarily the gender dysphoria.

More examples of children who went to Zucker’s clinic:

[W]hen asked why he wanted to be a girl, one 7-year-old boy said that it was because he did not like to sweat and only boys sweat. He also commented that he wanted to be a girl because he liked to read and girls read better than boys. An 8-year-old boy commented that “girls are treated better than boys by their parents” and that “the teacher only yells at the boys.” His view was that, if he was a girl, then his parents would be nicer to him and that he would get into less trouble at school. One 5-year-old boy talked about having a “girl’s brain” because he only liked Barbie dolls. In this particular boy’s treatment, he created drawings of his own brain, writing in examples of what made his brain more like a girl’s brain and what made his brain more like a boy’s brain (e.g., when he developed an interest in Lego). Over time, the drawings of the size of his girl’s brain shrunk and the size of his boy’s brain expanded.

Many of Zucker’s patients suffered from other various mental illnesses, like PTSD or autism. Had their parents taken them to an “affirming” clinic, it’s likely that they would have been fast-tracked on puberty blockers and hormones. According to Jamie Reed, a whistleblower who worked as a case manager for the Washington University Transgender Center at St. Louis Children’s Hospital in Missouri for four years,⁸ all it took to get a prescription for puberty blockers was a note from a therapist that the patient was required to see once or twice. She says that during her time at the clinic, “around a thousand distressed young people came through our doors. The majority of them received hormone prescriptions that can have life-altering consequences—including sterility.”

Lisa Marchiano is a Jungian analyst, social worker, and widely published author who, like a lot of therapists, began to notice the dramatic rise in female adolescents identifying as transgender in the past five years. But unlike many of her colleagues, she was skeptical of the phenomenon. She never doubted the distress of the teenage girls claiming gender dysphoria. But as someone who has studied the power of the unconscious, she was also keenly aware of how the mind is capable of deceiving itself.

When we feel psychological distress, she told Abigail Shrier, we want to explain it in a way that will make people take it seriously. “So if you manifest [distress] in some novel way that no one’s ever heard of before, the likelihood is you’re going to be dismissed. But if it fits into a prescribed narrative, the unconscious latches onto that. It has explanatory value for you and you receive care and attention.”

This idea was developed by psychiatry historian Edward Shorter, and popularized by journalist Ethan Watters. Patients are drawn to “symptom pools”—lists of culturally acceptable ways of manifesting distress that lead to recognized diagnoses. “Patients unconsciously endeavor to produce symptoms that will correspond to the medical diagnostics of the time,” Watters credits Shorter with discovering. “Because the patient is unconsciously striving for recognition and legitimization of internal distress, his or her subconscious will be drawn toward those symptoms that will achieve those ends.”

In his book Crazy Like Us: The Globalization of the American Psyche, Watters highlights how social contagions are spread this way. He uses the rise of anorexia in Hong Kong as an example. The city had never experienced an epidemic of young girls, captivated by a belief that they’re fat, engaging in self-starving. Not until 1994, that is, when local media widely publicized the story of a girl whose tragic death was characterized by news outlets as an example of a strange Western ailment called anorexia nervosa. This was followed by an outbreak of girls presenting with symptoms. It wasn’t that no young girls in Hong Kong had ever thought to starve themselves to lose weight; it was simply that only when anorexia became “a culturally agreed-upon expression of internal stress did it become widespread.”

Similarly, gender dysphoria has entered our symptom pool thanks to the proliferation of activists on YouTube and TikTok; Hollywood’s efforts to normalize transgenderism through shows like Orange Is the New Black and I Am Jazz; the media’s celebration of our “transgender moment” by popularizing figures like Caitlyn Jenner and Chastity Bono;⁹ and Democratic administrations pushing gender identity policies as a matter of civil rights in various domains including education, health care, and the military. As Abigail Shrier notes, such developments “have helped elevate gender dysphoria from something you might never have heard of to the first or second thought that pops into your mind when you see a boy clopping around the house in his mother’s high heels.” Once our 21st century symptom pool began including the notion that children can suffer extreme distress as a result of being born in the wrong body — lo and behold — gender dysphoria became widespread.

Encouraging children and adolescents to dissociate from reality, to believe that gender identity is intrinsic but sex is mutable, and to permanently harm their bodies in alignment with that gender identity in ways they could very well regret, is wrong. But expressing concern about young people suddenly identifying as trans has become politically unwise and socially verboten, something condemned by activists as evidence of a “transgender genocide.” These activists are exploiting a struggle that besets a tiny fraction of the adult population to bully and harass anyone who points out the sudden craze captivating despairing youth—a population abandoned by many on the Left in pursuit of identity politics and progressive bona fides.

Most prepubescent children who present with gender dysphoria have been confused by the rigid gender schemas that third-wave feminism helped erase, but which are once again becoming normalized thanks to gender ideology. Those closer to puberty, and especially teenagers, have in many if not most cases been introduced to an explanation for their angst and latched onto it. In this respect, gender dysphoria is no different than other “disorders of assumption” familiar to psychiatrists — i.e. anorexia or body dysmorphic disorder — that occur in people who come to believe that some of their psycho-social conflicts or problems will be resolved if they can change the way they appear to others.

Dr. Paul McHugh, former psychiatrist in chief at Johns Hopkins Hospital, argues that what these young people need is to be removed from the “suggestive environments” they’ve been immersed in and presented with a different message. But the proliferation of gender clinics in America and gender identity programs in schools, as well as the glamorization of transgenderism by Hollywood and the media, makes it less likely they’ll get the help they need to work out their issues. Instead, they find gender-affirming counselors and therapists who encourage them to maintain their false assumptions. This is contrary to standard medical and psychological practice. In what other circumstances does it make sense to encourage a child to persist in a belief that’s discordant with reality?

For the vast majority of minors, gender dysphoria will be a “transient phase.” It should be seen, first and foremost, as a psychopathology—something to be treated, not an identity to celebrate. Gender-affirming care, which is both a dereliction of duty by providers and a political agenda disguised as help, merely facilitates gender dysphoria and is tantamount to child abuse. Much in the same way that frontal lobotomy is now considered barbaric, fifty years from now we’ll look back on gender-affirming care as a cruel relic of the past.

1. As a recent headline in The Economist put it: “The evidence to support medicalised gender transitions in adolescents is worryingly weak.” But don’t worry, in recent years everyone from Jon Stewart and John Oliver to reporters and pundits at the New York Times, Washington Post and NPR have exaggerated the evidence for these interventions.

2. Cross-sex hormones carry side effects including sterility, psychosis, high cholesterol and blood pressure, and increased risk of cardiovascular disease and cancer.

3. This is something that even WPATH admits, and which conflicts with the unbelievably shallow and often dogmatic liberal view that these treatments are wonderful, safe, and shouldn’t be questioned. Where knowledge is lacking, ideology steps in.

4. Stopping puberty stops brain development.

5. Amazingly, in some states like Oregon it’s possible for 15-year-olds to get double mastectomies or genital surgeries without parental consent.

6. According to Reuters, the number of gender clinics treating children in the U.S. has grown from zero to more than 100 in the past 15 years. A Komodo analysis of insurance claims found that from 2019-2021, at least 56 genital surgeries and 776 mastectomies were performed in America on patients ages 13 to 17 with a gender dysphoria diagnosis. This tally doesn’t include procedures that were paid for out of pocket.

7. He was targeted by activists for his belief that children represent a special kind of gender dysphoria, and that their long-term well-being may not be served by automatically encouraging them to transition.

8. She’s also married to a trans man. This is worth mentioning because so many people have sought to discredit her by claiming she’s some transphobic bigot.

9. It certainly doesn’t help that much of the coverage of transgenderism is activism masquerading as journalism. With few exceptions, journalists focus on the feel-good aspect of children with gender dysphoria being accepted as the opposite sex, a triumph over adversity. They rarely if at all acknowledge detransitioners.