Why people believe the lies about gender-affirming care for kids

It isn't what the EOs say

Gender-affirming care (GAC) has been in the news a lot in the past few years, usually about banning it, especially for youth. But in this case, the news is a jumble of misinformation, disinformation, myths, and sometimes, evidence-based medicine and science.

Half of the States have banned GAC for youth, at least one for adults too, and several executive orders are attempts to destroy gender-affirming care. Every day, I read yet another headline about the federal government demanding it stop and framing it as harmful.

Why?

The arguments to ban care come from hate groups—not science,¹ not ethics,² and not health care providers (with a handful of transphobic exceptions with ties to said hate groups; see the link above). Part of my motivation for writing is to get accurate information to more people in hopes of dispelling some of the myths and misinformation.

We see what we want to see

Now, I could provide all the evidence and facts in the world, and that will not convince some people. All humans have cognitive biases that block us from seeing and understanding things that contradict what we think we know. This isn’t about how smart someone is or how educated they are. It’s just how brains work.

If we believe A, and x, y, z data come along that directly contradicts A, we will do all the mental gymnastics to dismiss x, y, and z. We will give it extra scrutiny. We will pick apart any little detail we can find to undermine it. We will dismiss the messenger as well as the information. We will block it out.

At the same time, if we believe A, and d, e, f data come along that seems to support A, we will readily accept it, without question, without scrutiny.

New information that contradicts what we think we know hits our bodies’ alarm bells and puts us into fight-flight-freeze-or-fawn mode. It can become an identity threat, challenging who we feel we are. In that mode, we cannot learn or think critically. We just double down as a defense to our identities.

The book White Fragility gets at this well, showing how when White people are told they are being racist, they get defensive, thinking, “But I’m a good person, and racism is bad, so I can’t be racist!” The book then helps White people get past that and see the systematic harms they are a part of and how White people benefit from the racist system, like it or not. (The first step in practicing anti-racism is to admit to being racist.)

I have an uncomfortable plethora of examples from my life.

• When I was a Mormon, I’d look at any other religion’s similarities as proof that Mormonism was The True Religion and the others managed to maintain bits of The Truth but not the whole thing. I read all sorts of stuff that contradicted the Mormon church’s claims. I disagreed with a lot of their teachings. Many of them made me extremely uncomfortable. But I pushed it all down because it contradicted The One True church idea. Finally, I realized I was starting with the assumption that it was the true church. I shifted my approach to “Let me start with a blank slate and see where the evidence falls,” and I was out within a couple of weeks.

• When I was trying my best to be a straight woman, I’d avoid dressing in anything that was masculine-presenting, lest anyone mistake me for a lesbian.

• When I was a wife, I was so convinced that my husband was The One for me that I ignored and reinterpetted the red flags in his behavior as “just a bad day,” or “he’s really stressed because of work,” or “it must be my fault; I just need to ask differently next time.” It took me five years after separating from him to see the truth in that relationship, while my therapist and psychiatrist saw it immediately. And my journals from the very beginning of the relationship are full of red flags that I wasn’t able to string together into one whole “this relationship is unhealthy for me.”

Because our brains do this, we have developed systems to help us overcome these biases. The scientific method and scientific peer-review are meant to do just that. Those don’t make individual people, even very smart, educated scientists, immune to bias, though. I catch myself in these biases and remind myself to apply the same level of scrutiny across the board.

I’ve been spending weeks reading the scientific literature about gender-affirming care and its benefits, and I have come across a handful of authors performing mental gymnastics and twisting evidence to support their underlying transphobic biases and assumptions. I am flabbergasted that some of them made it through peer review. Many of them did not—they are letters to the editors that have then been used in arguments to ban care! But overall, the power of science is that it updates according to the evidence; when we know better, we do better.

Media biases

The media coverage on trans issues had not been fair nor unbiased. There’s an incentive to get clicks and shares, not facts. The more controversial, the better!

This is what media coverage about trans issues looks like to me:

• The Times reports about a spaceship launch and gives 70% of the article to how flat earthers may really be on to something.

• An article recommending ways to make the classroom more ADHD friendly includes interviews with 5 supporters of eugenics, one neurodevelopment expert, and no one with ADHD.

• A local column about a new, improved wheelchair ramp installation interviews no one who uses a wheelchair but does interview a man who has never used any mobility aids. The man is quoted as asking why anyone would go around the back of the building to the ramp when the stairs are right there up front. The author says nothing about ableism and doesn't comment on how ramps are often in the most inconvenient places.

The people against GAC—and more broadly, trans people existing at all—have riled up the public’s and lawmakers’ fears with many lies. A huge one is the myth of performing surgeries on kids.

That idea is very scary, I admit. But it’s not happening to trans kids.

Surgeries are being done on intersex babies and children, so if you want to exert your horror and alarm at something, get educated about the intersex rights movement.

Unfortunately, the media has been giving outsized coverage to that handful of “Merchants of Doubt,” making it look like the science is unclear about gender-affirming care.

But it’s not.

The consensus is that gender-affirming care is helpful and life-saving. The guidelines are clear. The harms of withholding it are clear.

The criticisms come from that place of performing elaborate mental gymnastics, holding GAC to far higher standards than any other medical care. Once the data show their criticism and fear to be unfounded, they move on to a new one—ever-shifting goalposts. And they will continue to shift the goalposts because they don’t want to believe. They don’t want to accept it.

Why?

My theory (and I’m not alone in this theory) is that trans people, by our very existence, feel like an identity threat to them. We challenge the status quo of White patriarchy, which relies on a binary gender system. We show that breaking out of those gender boxes is possible. And they’ve pushed themselves into those boxes in ways they don’t like, and they resent us for not living in that same inauthenticity.

But for those who are curious, let’s talk about what gender-affirming care consists of for kids.

Gender-affirming care for kids

When we say gender-affirming care for kids, we mean support for their psychosocial transition. That is, believing them when they say who they are and giving them space and time to explore and experiment with that safely. There are no medical interventions for kids before puberty.

And that can take time. On average, trans kids arrive at gender clinics four to five years after first questioning³ their gender identities. Most people also have a long gap between when they realize they are trans and when they tell their parents or others.

We also mean (usually, but not always) social transition, presenting as the affirmed gender: clothing, hairstyles, change of pronouns, perhaps calling them a different name. The latest executive order frames this as child abuse, trafficking, and other horrible things. But the science is quite clear that parent, family, and provider support for social transition is positive—lifesaving.⁴

Parents who support their children through this process describe noticeable improvements in their children’s happiness and overall well-being.⁵ The science is also clear that quashing it or trying to get them to identify with or live as the gender assigned at birth is harmful to their mental health, leading to more suicidality.⁶

Once kids reach puberty, they can start puberty blockers, and around 16 or so, can start hormones. They can—but not all do. And that’s okay. I’ll save that for later posts.

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Chew, D., Anderson, J., Williams, K., May, T., & Pang, K. (2018). Hormonal Treatment in Young People With Gender Dysphoria: A Systematic Review. Pediatrics, 141(4), e20173742.

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Olson, K. R., Durwood, L., DeMeules, M., & McLaughlin, K. A. (2016). Mental Health of Transgender Children Who Are Supported in Their Identities. Pediatrics, 137(3), e20153223. https://doi.org/10.1542/peds.2015-3223

Durwood, L., McLaughlin, K. A., & Olson, K. R. (2017). Mental Health and Self-Worth in Socially Transitioned Transgender Youth. J Am Acad Child Adolesc Psychiatry, 56(2), 116-123.e112. https://doi.org/10.1016/j.jaac.2016.10.016

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