The Questions Journalists Aren’t Asking

Written by a Genspect parent

Like so many other parents, I felt a few shaky, nervous glimmers of hope seeing high-profile news outlets like the New York Times and Washington Post publishing stories in which doctors and psychologists are allowed to express their concerns that some gender dysphoric children are not receiving appropriate care and are being rushed into transitioning. Although we are glad to see this coverage finally happening, there’s a feeling of incompleteness and avoidance in these articles. We still are not getting the information we need. Whether through deliberate avoidance or their own lack of understanding, journalists routinely are not asking doctors and psychologists the critical questions that need to be asked.

The New York Times article, Doctors Debate Whether Trans Kids Need Hormones, is one of the most recent articles that avoids these questions. In this article, readers are informed – many for the first time – of the fact that adults and children are not universally required to receive psychological assessment or therapy before beginning medical interventions such as cross-sex hormones or surgeries such as breast and testicle removal. Readers may also be stunned to learn that there is a debate among doctors and mental health professionals whether this should be a requirement, even in the case of children and adolescents. Most people who have supported the freedom for adults and adolescents to medically transition based much of that support on the belief that any patient asking for treatments with such profound effects would have undergone extensive psychological assessments to make certain this was the best treatment and that there were no other underlying causes to the patient’s gender dysphoria that needed a different treatment. Certainly these life-changing drugs and surgeries, most of which come with permanent, irreversible outcomes, would not happen without such basic screenings, right?

But this article pulls the curtain back and lets the public see that not only is this not the case, but there are professionals fighting to prevent the requirement of therapy before taking such life-altering actions, even in the case of minor adolescents. Readers newly introduced to the world of adolescent gender medicine may be left wondering why any healthcare provider would be against what seems like such a commonsense requirement for adolescents. The adolescent period is well-documented for having shifting and developing identities, difficulty imagining and appreciating long-term consequences, discomfort with a rapidly changing body, and exquisite sensitivity to peer influence. This is an especially concerning considering the article acknowledges that “[f]ew studies have followed adolescents receiving puberty blockers or hormones into adulthood[,]” and that new proposed World Professional Association for Transgender Health (WPATH) guidelines “suggest minimum ages, lower than those in the previous version, for each treatment: 14 for starting hormone therapy, 15 for chest masculinization and at least 17 for more invasive genital operations.”

The NYT article attempts to cover both sides of the debate. Dr. Laura Edwards-Leeprer, a child clinical psychologist who helped set up one of the first youth gender clinics in the United States, says, “The kids presenting these days are very different than what I was seeing in the early days,” and “They absolutely have to be treated differently.” While Dr. Erica Anderson, a clinical psychologist who works with transgender adolescents and herself a transwoman, states, “The issues of inadequate assessment and what I have sometimes called hasty or sloppy care have resulted in potential harm.”

Representing the other side of the debate, the article quotes Dr. Alan Keuroghlian, a Boston clinical psychiatrist, saying, “I’m really not a believer in requiring therapy.” He goes on to say that requiring therapy for all adolescents “is inherently unnecessary” and “a waste of resources.” He adds that medical transitioning may resolve the mental health issues in some of these adolescents. The article also quotes Dr. AJ Eckert, medical director of Anchor Health Initiative’s Gender and Life-Affirming Medicine Program in Stamford, Connecticut, saying, “Forcing trans and gender diverse youth to go through an incongruent puberty can cause long-term trauma and physical harm.”

But here is where the elephant enters the room, where the weight of unasked questions starts to be felt. There is no countering of Dr. Keuroghlian’s objection that therapy consumes resources with the obvious fact that prescribing hormones and performing surgeries also consumes resources. He is never asked about the possibility of appropriate treatments for concurring mental health conditions resolving gender dysphoria. Dr. Eckert is never asked to provide evidence for the claims that puberty can cause “long-term trauma and physical harm,” and is never asked to specify what those traumas and harms actually are.

Then there’s this very serious question felt throughout the article: What about the adolescents who would benefit from therapy and might decide that transitioning is ultimately not the best treatment?

The article only briefly and obliquely approaches this question, first with this sentence early in the article:

And in some instances, thought to be quite rare, transgender people later “detransition” to the gender they were assigned at birth.

And then buried near the end of the article, a point long after many have stopped reading, the article admits:

…it’s unclear how often it (detransitioning) happens…”

This tweet exchange in the aftermath of the article, which involves Dr. Anderson, highlights the importance of asking questions and demanding specific, detailed answers. Do we feel the same about Dr. Anderson’s definition of a more cautious approach now that we know her definition of “enduring?”

So what other questions do journalists need to ask the professionals?

1. Do you believe that ALL cases of gender identity confusion are caused by gender dysphoria? There are literally no other possible causes that exist?
2. Do you believe that ALL adolescents should receive hormones and/or surgery if that is what they tell you they want? Are you asserting there is never a case of a teen being insistent, consistent, and persistent but ultimately wrong about medical transition being the right choice for them?
3. Do you believe you are 100% accurate, without fail, in being able to distinguish between those teens who are certain and correct they will benefit from transitioning?
4. Do you have well-established and replicated evidence that 100% of adolescents will benefit from medical (or even social transition) and that there will be none who do not?
5. Are you saying that misdiagnoses, regret, and detransition never happen?

Any professional who answers any of the questions above with a “yes” should be pressed to reveal their methods and sources.

And finally, this question, perhaps one of the most difficult to ask but the most crucial to know the answer to:

What are your feelings about the children you were wrong about? Did you feel that sacrifices must be made? That permanent harm to some children is regrettable but unavoidable? What is the acceptable number of mistakes? What do the medical and mental health professions plan to do about those they were wrong about?

Journalists must ask these questions and not stop until they get clear, specific answers.