Answering important questions about why gender affirming care should not be banned for youth
At what age do children become aware of their gender identity?
Children develop their gender identity as they are learning to speak. “Transgender children as young as age 3 have identified clearly and consistently with their current gender” and identify more with peers of their gender identity than the gender assigned to them at birth.
Children experience psychological difficulties because of “trauma and maltreatment stemming from gender diversity-related rejection”. (WPATH SOC 8, page S67.) Whereas “children who are well accepted in their gender diverse identities are generally well-adjusted”. (WPATH SOC 8, page S68.)
Studies show that young transgender children do need social support for their identities. Transgender children, like all children, have “positive mental health, less depressive symptoms, high self-esteem and life satisfaction in later adolescence” when they are supported in their identities.
What is the difference between sex and gender? Is sex binary?
If you are not accustomed to thinking about the difference between sex and gender, gender is a person’s internal identity, sex is their physical biology.
Sex isn’t binary in nature. Fish and lizards can change their sex to meet their needs. Chickens and even lions can exhibit characteristics considered both male and female.
Throughout history, cultures around the world acknowledged nonbinary sex and gender. (The division between sex and gender does not exist in many other languages.) This includes western Judeo-Christian culture, which for over two thousand years reflected the truth that human biology regarding sex can be as varied as it is in the animal kingdom. For instance, the Jewish Torah includes eight sexes:
- Male (“Zachar”)
- Female (“Nekevah”)
- A person who has both “male” and “female” sexual characteristics (“Androgynus”)
- A person whose sexual characteristics are indeterminate (“Tumtum”)
- A person who is identified as “female” at birth but develops “male” characteristics at puberty naturally (“Ay’lonit Hamah”)
- A person who is identified as “female” at birth but later develops male characteristics through human intervention. (“Ay’lonit Adam”)
- A person who is identified as “male” at birth but develops “female” characteristics at puberty naturally (“Saris Hamah”)
- A person who is identified as “male” at birth but develops “female” characteristics through human intervention (“Saris Adam”)
Similarly, in Matthew 19:12 in the Bible, Jesus acknowledges the existence of multiple sexes, to include people who were born neither male nor female, people whose sex was neither male nor female through human intervention, and even compared people whose sex was not binary to the priesthood and therefore himself. Gender and sex diversity was as worthy of reverence two thousand years ago, as it is today.
Studies show that approximately 1.7% of the population could be considered intersex, neither exclusively male nor female, by their characteristics at birth. That number would be even greater if it included intersex conditions that become apparent at puberty.
The concept of a binary sex came not from religion, which two thousand years ago considered sex and gender diversity true and worthy of reverence, but from the 20th century eugenics movement, misclassifying the natural variation people experience in sex as a disorder to be fixed to conform with an artificial gender and sex binary.
Gender affirming care bans continue this eugenic legacy, by declaring that intersex children to be exempt from the provisions of the bills, subject to involuntary procedures they may not want, at ages too young for them to know that they are happening, while it also bans lifesaving procedures for transgender children recognized as medically necessary by every major U.S medical and mental health organization including the American Medical Association, the American Psychiatric Association, and the American Academy of Pediatrics. Gender affirming care bans are not about protecting children. They are about controlling the bodies of both intersex and transgender children, to have them conform to an artificial binary that they may not wish to apply to them.
Why is access to gender affirming care so important?
Gender affirming care is crucial life-saving care for transgender people, recognized as medically necessary by every major U.S medical and mental health organization including the American Medical Association, the American Psychiatric Association, and the American Academy of Pediatrics. A recent survey of peer-reviewed scientific studies by the World Professional Association for Transgender Health (WPATH), demonstrates hundreds of studies showing culminating in a recommendation that “health care systems should provide medically necessary gender affirming health care for transgender and gender diverse people” and that denying access to gender affirming care leads to serious injury and death.
Should transition be banned because some people “detransition” or stop being transgender?
A 2022 five year study of transgender children determined that 99.5% of children who transitioned between the ages of 6 and 12 remained transgender or nonbinary.
Additionally, a study of people who have detransitioned show that of people who detransition, “82.5% cited at least one external factor” such as discrimination, stigma, or lack of support, as compared to only “15.9% of respondents cited at least one internal factor” such as questioning their own identity.
A recent survey of hundreds of peer-reviewed scientific studies by the World Professional Association for Transgender Health (WPATH), determined that “no clinical cohort studies have reported on profiles of adolescents who regret their initial decision or detransition. Recent research indicate there are adolescents who detransition, but do not regret initiating treatment as they experienced the start of treatment as a part of understanding their gender-related care needs.”
Gender affirming care bans are not about protecting the 0.5% of children who may detransition, 82.5% percent of whom detransition because of external factors like stigma that gender affirming care bans continue.
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Mika Fernandez (she/her) is president of the transgender rights organization Trans Formations Project, as well as a transgender, nonbinary, and intersex attorney, advocate, and researcher with over a decade of experience working on racial justice, gender justice, and youth civil rights work. Thank you to E.Z. for their research assistance with this article.
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