"The Science is Settled"

Turns out that the evidence base for interventions in youth gender medicine is threadbare. Who would have thought?

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We often see wokeness and its religious identitarianism as frivolous, ridiculous nonsense, “ideological exuberance” among those of the left-wing persuasion. But it’s actually a far more serious phenomenon that has warped people’s minds in deeply consequential ways.

See for example the neo-religion of gender ideology, its apparatus of medicalized malfeasance that masquerades as all that is righteous and good, and its ideologues who have pressured children into potentially life-ruining decisions.

That last part has been a tale of disfigurement, experimentation, and exploitation. The medicalization of children who might simply have been distressed by the idea of puberty or growing up — as opposed to “being born in the wrong body,” as trans activists claim — will go down in history as a scandal of epic proportions. A long-awaited report released earlier this month seems to all but confirm this. Exhaustive and level-headed, The Cass Review (written by Dr. Hilary Cass) is a 388-page critical analysis of the UK National Health Service’s failings in relation to gender-confused youths that strikes hard in an area of public policy where fashionable cultural values have overtaken evidence, safety, and biological reality. It serves as a damning indictment of “gender-affirming care,” which is based on the notion that a child’s early declarations of identity must be accepted at face value and their transition aggressively assisted, essentially treating the child’s feelings as an infallible indicator and immediately beginning a regimen of hormones and puberty blockers.

Among the reports conclusions:

• Thousands of vulnerable young people were given life-altering treatments with “no good evidence on the long-term outcomes of interventions to manage gender-related distress.” 

• Socially transitioning a child — i.e., allowing a child to change names and pronouns and “present” as the opposite sex — makes it more likely that he or she “will proceed to a medical pathway,” a self-fulfilling protocol that sets the child on a course with its own momentum, each step reinforcing a trajectory that leads to irreversible outcomes.¹

• “There is no evidence that puberty blockers buy time to think,” writes Cass, and they induce “no changes in gender dysphoria or body satisfaction.”²

• “It has been suggested that hormone treatment reduces the elevated risk of death by suicide in this population, but the evidence found did not support this conclusion.” Cass adds that “There is also a lack of evidence that hormones improve a young person’s body satisfaction and psychosocial health.”

• “Social justice” ideology and its cultural pressures are driving medical decision-making, and “the toxicity of the debate” has created an environment “where professionals are so afraid to openly discuss their views.”

• The increased social acceptance of trans phenomena is not a sufficient explanation as to why there’s been a massive increase in the number of children struggling with gender dysphoria, nor does it explain the recent shift in the gender dysphoric population from male to female majority, which is “unlike trans presentations in any prior historical period.” In other words, there is a huge social contagion factor at play.³

The Cass Review is the most thorough review ever undertaken on the medical evidence for transitioning gender-confused children, an impartial work on a subject for which only extreme partiality has ever been permitted (which is why the high priests of gender ideology are fuming). Dr. Cass may not have defeated gender extremism, but she has thrown down a gauntlet.

The obvious question that should be asked is how any of this has been allowed to happen. Neuroscience shows that an adolescent’s brain is too immature to make reliably rational decisions, and yet people have gone along with the idea that impressionable and confused children can make decisions about their gender identities and serious medical treatments. In the name of gender ideology, which has managed to infiltrate every corner of society, we have seemingly thrown everything we know about both child development and child safeguarding out of the window.

Growing up is a time of experimentation, when youngsters try on different identities as they progress toward adulthood, but by affirming children in the magical belief that they are the opposite sex, adults have cheered on the mass medicalization of what for many young people will have been merely a fad. Common sense would seem to suggest that an adolescent who comes to see him or herself as transgender might be experiencing social or emotional problems that precede concerns about their gender identity, or is simply under the influence of a peer contagion. Is it not possible that other psychosocial issues and factors might underlie their false assumptions?

The thing that needs to be talked about more is how children are being encouraged by trans activists — many of whom aren’t even trans themselves — 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 that many will come to regret. These are adult thoughts being put into kids’ heads; they don’t come up with this stuff on their own.

The trans movement depends upon continual validation and confirmation from an external audience and the legitimization of a regressive set of beliefs that forces a subjective and manipulable view of one person’s self to become a defining reality for everyone else. It is helmed by a tiny community of radical spazzes who share an evangelical-like zeal and rely on unquestionable dogmas to avoid the reasoned scrutiny that would otherwise unravel their gender Scientology. All debate and critical discussion is treated as a threat to “life-saving” public affirmation and is often curtailed or censored outright on the grounds that it “questions the right of trans people to exist.” Ironically, while trans rights are promoted in the name of tolerance, their enforcement is often extremely intolerant not just of criticism but of any degree of discussion. This pervasive insecurity underscores trans activists’ increasingly authoritarian behavior.

And it is not an exaggeration to say that the trans agenda — which is now formally taught and sanctioned in the context of K-12 education — is an effort to entrap children into a miserable life of despair to help normalize the mental illness of a very small number of adults.

With the help of progressive teachers, activists are exploiting this vulnerable group to promote their own interests. The focus on youth hides an adult agenda behind concern for the plight of children, which gives the movement a certain moral authority. The existence and increasing visibility of trans children provides evidence for the claim that trans individuals are “born this way,”⁴ and that “gender is a spectrum” irrespective of anatomical sex. This allows activists to dress up metaphysical bullshit as scientific fact. Moreover, having kids as the face of transgenderism helps activists deflect criticism and questions, and it legitimizes the demands they’re making of the rest of society. (“Think of the children!”)

But it’s not just trans activists and K-12 teachers who are pushing gender ideology onto children and encouraging them to transition. It’s liberals and progressives in general, particularly those in positions of power within the realms of media, education, academia, social work, medicine, law, and local and national government.⁵ It is because of them that trans individuals are valorized as struggling victims of a cruel world and forward-thinkers bravely pushing to expand society’s boundaries; it is because of them that the process of transitioning has been glamorized and romanticized; it is because of them that children have been misled to believe that changing one’s gender is a route to the seductive lilt of social acceptance, popularity, and group membership under the avant-garde LGBTQ umbrella.

These liberals and progressives, who are too sophisticated to abide by outdated notions of biological reality, and for whom status is defined by having the right opinions on social and cultural issues, express support for the trans agenda as a way to profess their religious faith in the Church of Woke, signal their moral and spiritual enlightenment to the unreformed, and publicly avow their commitment to the quest for social justice. They are absolutely convinced that imposing gender ideology on the masses is simply the next step in a narrative of Progress™, that transing children is in keeping with the emancipatory trajectory the West has been on ever since the Enlightenment. And, because they’ve framed “gender-affirming care” as a human and civil rights issue, “the imperatives that flow from it are absolute and not susceptible to the normal compromises of normal politics,” as Wesley Yang puts it. Such “just” and “virtuous” causes demand that all moral constraints be eschewed.

Thanks to the Cass Review, a new era in the care of children and adolescents with gender-related distress has begun in England. But I’m skeptical of the impact it will have in the U.S.⁶ during a time when a commitment to “inclusion” and ultra-contemporary, compassionate exhibitionism are requirements to remain in good standing on the Left. And given the implicit threat of consequences for those who stray from the neo-religious line, only full prostration before the gender faith suffices—to say nothing of the fact that fidelity to manifest absurdities remains a key way to demonstrate unswerving allegiance to elite opinion, which has become essential if you want to get ahead in politics, culture, business and, it seems, education.

The reality is that virtue-signalling and being on “the right side of history” has replaced genuine virtue and rational thought among our supposed betters, who have allowed themselves to be taken in by a trendy ideology and faddish folly, abdicating their responsibility to protect children and hiding behind duplicitous platitudes that masquerade as incontrovertible truths. Accordingly, the Left will no doubt continue to teach young people that the rejection of traditional notions of feminity and masculinity is a medical condition that requires treatment in the form of puberty blockers, cross-sex hormones, and surgeries.

And even when this deranged ideology finally collapses in on itself like a dying star, and gender dysphoria is finally seen as a psychopathology that should be treated rather than an identity to be celebrated, those who supported the medicalization of children will remain wrapped in the mantle of moral absolutism. They will not apologize. Their alibi will be that Good People™ couldn’t help but be swept away by this multi-year ideological intoxication.

1. When you socially transition a child, it increases the likelihood that these medical interventions will be lifelong. You make permanent what might have been temporary. This is known as iatrogenesis: the treatment creates the condition.

2. The most commonly used puberty blocker, more properly called a Gonadotropin-Releasing Hormone agonist (GnRH), was developed to treat end-stage prostate cancer. Prescribed under the brand name Lupron, it is also the same drug that is used to chemically castrate sex offenders. The side-effects can be brutal. The use of GnRHs in childhood has been linked to a permanent loss of bone density, damage to organs, and lowered IQ. So, a drug developed for terminally ill men, which is also used to castrate convicted male pedophiles, is being given to healthy children because it is “life-saving” for them.

3. According to Reuters, 15,000 kids aged 6 to 17 were diagnosed with gender dysphoria in 2017. That number jumped to 42,000 in 2021. But more than any other demographic, it’s teenage girls who are seeking help with their gender identity: in recent years there’s been a 4,400% increase in the number of girls being referred for treatment.

4. As Jo Bartosch points out, this helps hide the fact that for some men, there is a sexual driver behind the desire to identify as a woman, and nefarious reasons for their demand to be allowed into women’s spaces.

5. Note that the reason gender ideology has so successfully pervaded society is because progressives control so many major institutions in America now. Conceptual engineering can be effectuated in large part through a non-electoral politics of institutional capture.

6. Leading medical bodies still recommend the “affirmative model of treatment” that holds “a child of any age may be cognizant of their authentic identity and will benefit from a social transition at any stage of development.”