The costs of gender reassignment treatments

I have been trying to read a variety of articles to gain an understanding of the transgender issue. This one from First Things had a helpful summary of the scientific case against the celebration of gender-changing treatments:

Until recently, gender dysphoria in young people was treated by “watchful waiting” or by counseling. In 2007, however, Dr. Norman Spack of Boston Children’s Hospital introduced a new treatment protocol—originating in the Netherlands—which is fast becoming the norm. Today, young people who pursue “gender reassignment” begin a process that will consign them to lifelong dependence on the medical system. Generally, they receive puberty blockers at around age thirteen and begin opposite-sex hormones—estrogen for boys and testosterone for girls—at around age sixteen. Some eventually opt for “sex-reassignment” surgery. This can involve double mastectomies, in girls as young as sixteen, and removing or “creating” penises and vaginas.

Cross-sex hormones stimulate the development of secondary sex characteristics such as facial hair in females and the swelling of breast tissue in males. Most such changes cease when a patient stops using these hormones. The artificial “penises” and “vaginas” constructed through surgery do not function like their authentic biological counterparts. No treatment can cause a biological man to menstruate or give birth to an infant, or make it possible for a woman to produce sperm and father a child.

Gender transition treatments involve significant risks. Puberty blockers stunt growth and decrease bone density during use. Girls who take testosterone may develop serious acne or feel irritable, aggressive, or unbalanced. Individuals taking these hormones require lifelong monitoring for a number of dangerous side effects, including cancer and deep vein thrombosis.

Lifelong infertility may be the greatest risk of cross-sex hormone use by young people. Sterility is inevitable when puberty blockers are followed by cross-sex hormones at an early stage of adolescent sexual development, or if prepubertal children are placed directly on these hormones, according to Dr. Michelle Cretella of the American College of Pediatricians. Postpubertal adolescents are advised to consider freezing their eggs or sperm before beginning hormone use. “If your teen may want to have a biological child, it’s important to look into sperm banking before treatment is started,” Seattle Children’s Hospital advises parents. Hormone-induced changes “may be irreversible” for girls who receive testosterone, the hospital adds. “It’s very important that a patient starting [female-to-male] therapy be sure this is the course they [sic] want to follow,” its web site warns. Despite these concerns, Seattle Children’s Hospital enthusiastically supports pediatric gender-transition treatment and opened a clinic to provide it in October 2016.

In short, the use of sex-reassignment treatments in children amounts to a massive uncontrolled experiment. Such an unscientific approach to irreversible, life-altering treatments is indefensible in the age of “evidence-based” medicine, when lengthy clinical trials are generally required for federal approval of a new medication.

There is little evidence that cross-sex treatments actually benefit gender-dysphoric youngsters. In 2014, Hayes, Inc.—a widely respected research firm that evaluates the safety and value of medical technologies—performed a comprehensive review of the scientific literature on treatment of gender dysphoria. Hayes gave its lowest rating to the use of puberty blockers and cross-sex hormones in children, finding that the literature is “too sparse and the studies [that exist are] too limited to suggest conclusions.”

McHugh compares treating the psychological confusion of gender dysphoria with hormones or sex-change surgery to treating anorexia with liposuction. He notes that the most thorough follow-up of individuals who have had sex-reassignment surgery, a 2011 Swedish study, found that sex-reassigned individuals were almost five times more likely to attempt suicide and nineteen times more likely to die by suicide compared to controls. Such treatment is irresponsible. It leaves a patient’s underlying psychological problems undiagnosed and unaddressed. In McHugh’s words,

Transgendered men do not become women, nor do transgendered women become men. All . . . become feminized men or masculinized women, counterfeits or impersonators of the sex with which they “identify.” In that lies their problematic future.

Because the author’s arguments agree with my position, I am inclined to find it helpful. But if others know of scientific arguments in favor of gender-changing treatments, I would be grateful to see them as well.



  1. Fascinating excerpt! I basically agree with the author, too, but I’ll share some of my experiences.

    The scientific arguments I’ve come across on the other side revolve around surveys of satisfaction, preference, and expert opinion, but as Kersten kind of implies, the problem is that the more objective suicide rate does not seem to substantially improve with treatment or social acceptance, so it is hard to take those surveys at face value.

    Also, the distribution of brain white matter in males and females differ and there are studies which show that adult transgenders can be up to a little over half-way between males and females in select statistical metrics of white matter. That would suggest some kind of biological change, perhaps hormonal or via some feedback mechanism.

    But various non-normal white matter distributions are also correlated with a wide variety of psychological disorders and even homosexuality. So, transgenderism might still be considered a particular kind of psychological issue, like body dysmorphic disorder with a compulsion to control perceptions.

    There’s also commonly a lack of proportion in these physiological arguments, since there is obviously far more physiological similarities of transgenders to their birth genders than their chosen gender. So, the popular idea that people are simply born with opposite sex brains seems overblown at this point.

    DNA oddities and intersex examples are often used to argue a non-binary male-female paradigm, even though they are rare and likely sterile in some fashion. Given that bate as proof, they then switch to gender reassignment as if the same ambiguity exists there, too.

    One funny side-effect of transgenders wanting to be seen as the opposite sex is that they depend upon discrimination between the sexes. Transfemale athletes, for example, want to compete against biological females. So typical equality arguments don’t quite work which complicates matters for feminists.

    As with other branches of critical theory, arguments typically center on perceived oppression and redefining terms, like “gender”. They basically assert that one’s feelings about their identity should outweigh reproductive capacity in defining male and female — that how they want to be seen by you should outweigh how you actually see them. I’m not sure if this could be called “individualism”, but if so, it is very one-sided.

    As with many of these kinds of social issues, to me, the objective and defining distinction always seems to come back to children.

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