In the New York Times Magazine article “The Battle Over Gender Therapy,” journalist Emily Bazelon describes the conflicting views of several medical doctors and psychologists. They disagree over timing and access: who should decide whether a young person receives gender-affirming medical care, and how long should this decision-making process take?
In general, waiting before finalizing a decision is best. This is true whether they are big decisions – like getting married or buying a house – or relatively small decisions – like buying a new couch, posting an irate Twitter message, or drinking another beer. If you can give yourself time to mull it over, you’ll probably be happier with your resulting decision, even if you end up doing the same thing.
In the film Searching for Bobby Fischer, a chess instructor attempts to teach this patience to his student:
“So what’s your best move?”
“Rook to d.”
“What about taking on e?”
“What about it?”
“You didn’t consider it. You’re still not considering it.”
“I’m right. Rook to d is the best move.”
“You didn’t study the board!”
Even when the answer seems clear, it’s still often better to take time to think. To plan, to weigh options.
But we don’t always have this luxury. Sometimes, when considering whether to buy a house, people feel forced to make a decision immediately – otherwise, someone else might buy it! These snap decisions, like the home purchases that many people made during the pandemic, are more likely to lead to regret.
For a person seeking gender-affirming medical care, deciding to begin hormone therapy might be an even bigger decision than getting married or buying a house. Hormone therapy can cause irreversible physical changes. For a person who was assigned female at birth, taking testosterone often results in a permanently deeper voice; reshaping of the face to appear more angular; changes in the shape and size of genitals.
Similarly, when a person who was assigned male at birth uses hormone therapy to help their appearance and physiology better match the gender of their brain, an analogous set of changes may linger even if this person decides to stop taking the medications.
And, yes, some people will decide to stop taking the medications. As with any medical treatment, hormone therapy has both benefits and side-effects, and it’s hard to know how these will balance out for a particular individual’s brain & body before they try.
So, it’s a big decision. There are irreversible changes. Obviously, taking a lot of time to wait and evaluate would be best, right?
But sometimes, competing urgency makes waiting impractical. As an example, consider surgical removal of an organ. This is a drastic measure: you’d like to wait and mull things over. Unfortunately, time pressure from the septic shock of an advanced bacterial infection might force a quick decision. My friend was barely conscious during this decision-making process after collapsing in the lobby of our local hospital.
When deciding whether or not to initiate gender-affirming hormone therapy, there’s a bit more wiggle room. But for a young person who’s mustered up enough self-knowledge and courage to talk to their parents or healthcare provider about wanting medication, there is still looming time pressure.
During puberty, bodies can change very drastically within a matter of months. Many of these changes are lifelong and irreversible. Waiting to evaluate isn’t just a default, low-impact choice. Hormone therapy is a big deal, but waiting will also bring dramatic, permanent physiological changes. Not to mention continued psychological turmoil, which might be compounded by the knowledge that, for all of your bravery in speaking up, you’re still not getting the help you need.
My main qualm with Bazelon’s article? For all the nuance devoted to the medical doctors’ and psychologists’ opinions, we hear very little from young people. Bazelon interviewed over 60 clinicians, researchers, activists, and historians, but only half that many of the young people whose brains, bodies, & lives are at stake. As a parent, I’m aware that children can do or say a lot of irksome, irrational things; as someone who works with elementary and high-school students, I also know that we have to recognize young people as valid knowers and thinkers.
I want to hear about the sense of urgency from young people themselves. Instead, this central issue was only passingly mentioned in a single sentence, a quote from child psychologist Laura Edwards-Leeper about the process of evaluating young people for gender-affirming treatment: “If a child was on the cusp of puberty, and anxious about how their body was about to change, we tried to squeeze them in faster, which I still think is really important.”
Young people have a stake in our world. And yet – with our inaction on climate change; our mass production & sale of military-grade weaponry to anybody who wants it; our treating schools as a lower priority than bars or restaurants during the pandemic, and then keeping schools closed or disrupted even after we had data showing that these disruptions were causing children even greater harm than Covid-19 infection; our age- and wealth-based prejudices that give retirees a far greater say in the future of our country & planet than the young people who will inherit the mess – we are not only disenfranchising young people, but abjectly failing them.
Young people have not been silent. We ought to listen.