On June 15, the White House issued an executive order promoting the expansion of gender-affirming services, including for children and teenagers. The order represents the Biden administration's latest effort to expand legal protections based on sexual orientation and "gender identity."
While sexual orientation is widely acknowledged and respected, the concept of "gender identity" remains novel and highly contentious. Dissenters, including many feminists, argue that allowing people to identify into whichever sex category they choose carries negative consequences—particularly for women and children's rights.
Biden's executive order seeks to "promote expanded access to comprehensive health care for LGBTQI+ individuals, including by working with States on expanding access to gender-affirming care." When it comes to sex and gender issues, the "gender-affirming" model argues that health care professionals must not question, challenge or even explore ideas or alternatives with patients who identify with the opposite sex. Therapists are simply tasked with affirming patients' rejection of their biological sex, forbidden from questioning the underlying reasons behind these feelings.
The federal government's decree that this model is the only way to deal with cross-sex identification raises important questions about the medicalization of youth who desperately want to escape their bodies, and the freedom of professionals whose first commitment is to do no harm.
It is of paramount importance that therapists explore why an increasing number of children and teenagers feel so distressed by their own bodies. Oftentimes, it is actually sexist expectations around femininity and masculinity that young people are seeking to escape. When left alone without any medical intervention, the vast majority outgrow this distress. Many children and young people who reject their sex have experienced abuse or trauma, are on the autism spectrum or feel uncomfortable with developing same-sex attraction. Yet policies and legislation that demand clinicians—and broader society—never ask why young patients wish to "change sex" risks harming the very population they seek to protect.
Therapists wanting to explore the underlying discomfort behind these feelings risk being accused of engaging in "conversion therapy"—that is, seeking to coerce young people out of their "gender identity." And the White House has, in the same executive order, signaled support for eradicating this practice. Biden states:
My Administration must safeguard LGBTQI+ youth from dangerous practices like so-called "conversion therapy"—efforts to suppress or change an individual's sexual orientation, gender identity, or gender expression—a discredited practice that research indicates can cause significant harm, including higher rates of suicide-related thoughts and behaviors by LGBTQI+ youth.
Around the world, proponents of "gender identity" policies have been working hard to impose legislation that bans conversion therapy based on "gender identity" precisely as gender-affirming care for children and teens is becoming increasingly controversial. As a result of grassroots pushback from ordinary people and campaigners, countries are being forced to pause and commit to better scrutiny of this medical model. Simply put, an abusive training program that seeks to indoctrinate a boy out of being attracted to other boys is not equivalent to a therapist who wants to explore why a girl with a history of sexual abuse suddenly demands to be medicalized with testosterone and be perceived as a male by society.
This past May, the U.K. government was determined to outlaw conversion therapy for both sexual orientation and "gender identity," but pushback from the public forced it to separate the concepts and eliminate the second from its proposals. Feminist campaigners argued that therapists need the freedom to explore sex and gender issues with their patients without the threat of being charged with a crime.
Studies from Sweden show that referrals of young people to gender clinics have dropped following media exposure of the experimental nature of these clinics, and of the long-term health ramifications for young people. Australia's biggest gender clinic used to tell patients and their parents that puberty blockers—prescribed to children 9 to 13 to suppress their natural sex hormone development—were fully reversible and caused no long-term damage, and has had to backtrack. It now admits that puberty blockers "might conceivably delay brain development" and states in its June newsletter, "We do not know whether using puberty blockers affects development of the brain."
Given the global context, why the rush to affirm children and teenagers who reject their sex and to condemn anyone who wants to explore why so many young people feel desperate to escape their bodies? Around the world, feminist campaigners have been raising awareness of the dangers of medicalizing children and encouraging them to hate their biological sex. Now people from all walks of life are pushing back and demanding more scrutiny around "gender identity" policies and what it means for their lives.
At the same time, society is finally beginning to hear from young people who lived through the gender-affirmative medical model, and have since regretted it. Detransitioners, as they are often called, risk rejection from the very community that encouraged their transition and the deep shame of admitting they'd made a grave mistake. Having to live with the consequences of a gender-affirmative model that did not encourage them to pause and think things through, detransitioners now advocate for more caution and thoughtfulness rather than rushed legislation and policy initiatives.
When it comes to demands to affirm young people who reject their sex, the voices of powerful lobby groups and politicians should not be prioritized above all others. We must listen to the voices of the young people who bear the physical and psychological scars of a gender-affirmative model that was quick to diagnose and medicalize them as children, but slow to ask questions about what would happen to them once they became adults.
Raquel Rosario Sánchez is a writer, researcher, and campaigner from the Dominican Republic.
The views expressed in this article are the writer's own.
