The truth about transgenderism is coming out. On Monday, Michael Shellenberger released a multitude of internal files from the World Professional Association for Transgender Health (WPATH) that “prove that the practice of transgender medicine is neither scientific nor medical.” WPATH has been accepted by the political, cultural, and medical establishments as the authority on transgenderism, but what its members say in private is not the narrative they sell to the public.
Instead of the rigorous, careful, evidence-based medicine that champions of “gender-affirming care” claim to practice, the WPATH files show doctors who are making it up as they go along, smashing through guardrails even though they know that the children they are chemically and surgically altering cannot really give informed consent. And people are noticing.
No wonder the transgender ideologues are worried. The public has proven more resistant than they expected, especially regarding radical policies such as putting men in women’s prisons and girls’ locker rooms, let alone sexually mutilating and sterilizing children. And transgender activists and their allies have no response except to repeat their same failed arguments, just louder.
Consider a recent opinion piece in the New England Journal of Medicine by Michael R. Ulrich, a Boston University professor of law and public health who is also affiliated with Ibram X. Kendi’s scandal-plagued Center for Antiracist Research. Ulrich argues that restrictions on transitioning children are part of a broader right-wing culture war restricting and regulating medicine. There is a lot wrong with this assertion, but the fundamental problem is that so-called gender-affirming care is not medicine.
From puberty blockers to hormones to surgeries, transition is never medically necessary. Transitioning does not cure any disease or correct any physical ailment or injury. Rather, the point of medicalized transition is to disrupt and destroy the normal functioning of healthy bodies.
Ulrich tries to assuage concerns over these procedures by comparing them to “Pediatric chemotherapy and radiation,” which also “have lasting effects on growth development and reproductive capabilities.” Well, yes, but cancer kills people, which is why we are willing to accept serious side effects to treat it — and even then, doctors and patients have to balance the risks of the disease against the risks of treatment. In contrast, there is no physical risk from not receiving “gender-affirming care,” whereas, as the WPATH files show, there is significant, potentially lethal, risks from puberty blockers, cross-sex hormones, and transition surgeries.
This is why the argument for transition always comes down to encouraging people, especially children, to take themselves hostage by threatening suicide. The only harm that can come from not transitioning is self-harm. And so Ulrich deploys the suicide threats early and often, writing that “it is not hyperbole to say that lives are at risk in states pursuing these bans on needed care.” Ulrich offers no real evidence to back this claim up. He simply presumes that the “high rates of suicide, suicide attempts, and suicidal ideation among transgender young people” would be reduced with affirmation and medical transition.
Ulrich cites just one study as “evidence showing the effectiveness of gender-affirming care in reducing depression, anxiety, and suicide attempts.” But, despite hype to the contrary, that study showed no such thing. Rather, as Jesse Singal explained after it was published in 2022, “the kids who took puberty blockers or hormones experienced no statistically significant mental health improvement during the study. The claim that they did improve, which was presented to the public in the study itself, in publicity materials, and on social media (repeatedly) by one of the authors, is false” (emphasis in original).
No Evidence Regarding Suicide
There is no good evidence that transition prevents suicide, especially for children. Those who identify as trans do have an elevated risk of suicide (though this tends to be exaggerated by activists), but this is best explained by trans-identified individuals also having a much higher rate of mental health problems and trauma — and it doesn’t help to add to these underlying issues the lie that they were somehow born in the wrong body.
This extraordinary claim — that some children are born into the wrong bodies, and therefore must be chemically and surgically reshaped into a facsimile of the opposite sex — is medically unsupported. It is ideological and sexual fantasy masquerading as medicine. There is no good evidence to support transitioning children because gender ideology is just that, an ideology masquerading as medicine. The reality of human nature does not change, even though much of the medical establishment, such as the NEJM, was shamefully eager to capitulate to a small number of aggressive activists.
Rein in the Industry
Therefore, it is not only reasonable, but imperative, for legislators to rein in the transgender industry, and especially to stop the “transitioning” of children. Ulrich and other activists can fulminate about right-wing conspiracies, but it is right and just to ban the surgical and chemical mutilation of children. Many states have done so, thereby proving that gender ideology will not inevitably triumph and claim our children for its own.
This does not mean the fight is over. Indeed, we should expect gender ideologues to become more aggressive as their losses pile up. They thought time would be on their side, and that new research would vindicate them. But their time is running out, and the continued lack of evidence for “gender-affirming care” is pushing them to increasingly brazen lies and distortions as they attempt to justify their collapsing position. And they are also becoming more authoritarian in the places and institutions they do control, as they attempt to impose transgender dogma on the rest of us.
Thus, those opposed to gender ideology must not get cocky. Trans activists and their allies will keep fighting to the bitter end, especially those who have staked their reputations, livelihoods, and self-respect on radical gender ideology. Nonetheless, the end can now be envisioned, even if much work remains to achieve it.
Nathanael Blake is a senior contributor to The Federalist and a postdoctoral fellow at the Ethics and Public Policy Center.
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