When did “being yourself” begin to require major medical alterations to healthy bodies?

John SikkemaOver the weekend delegates at the Conservative Party’s National Convention voted to support a ban on treating gender dysphoria in children with pharmaceutical and surgical interventions.

This followed recent moves by the governments of New Brunswick and Saskatchewan to change school policies to ensure greater parental involvement in decisions to change a child’s name and pronouns at school when a child self-identifies as transgender. Ontario’s Education Minister also recently expressed support for these changes in principle.

Some people are lamenting such developments as a spillover of American culture wars into Canada and, worse, a manifestation of “transphobia”. But that is a facile dodge. There is an important debate to be had here.

Sadly, many children today experience distress about their bodies – about being male or female and about sexually maturing into a man or woman. They may say they feel stuck in the “wrong” body. A technical term for this is “gender dysphoria.” It has risen exponentially in children in the past decade, especially among teen and pre-teen girls. Plenty of evidence suggests that this rise is largely a social phenomenon or “social contagion”.

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Photo by Annie Spratt

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People who support medical transition for minors believe they are supporting kids’ freedom to “be themselves”. But it’s not so simple. A person’s self-conception can change. His or her DNA and biological sex cannot change (though pharmaceutical and surgical interventions can make somebody appear more masculine or feminine). In a fundamental sense, you are your body. You didn’t choose it. You wouldn’t exist without it.

Male and female bodies are good and beautiful just the way they are. Boys should be free to take joy in picking flowers or playing with babies without questioning if they’re in the wrong body. Likewise, girls should be free to love sports, find bugs, or be uninterested in dresses or dolls while still accepting and celebrating their natural bodies.

But our culture presents a mess of conflicting messages: airbrushed, impossible standards of beauty and people as sexual objects on the one hand; messages of body positivity and self-acceptance(“love the skin you’re in,” “amazing just the way you are”) on the other, and so on. When did “being yourself” begin to require major medical alterations to healthy bodies?

We should not teach children to question basic bodily realities, as our schools currently do, by teaching them that their body might not match their “true” identity. Not only does this reinforce tired gender stereotypes, but it also causes mental and physical anguish.

Using puberty blockers, cross-sex hormones, and even so-called gender reassignment surgeries on minors is quite new. The negative side effects are many. While most children overcome gender dysphoria by adulthood without pharmaceutical or surgical interventions, once a child is given puberty blockers, that decision usually proves fateful, as most who start puberty blockers go on to also receive cross-sex hormones.

This helps explain parents’ desire to know what is going on with their child at school since school is where a child might start to identify as trans and be affirmed in that identity. By the time a child is convinced that he or she is trapped in the wrong body and needs medical treatment, a concerned parent will be in a very difficult position.

Puberty is a natural process that is important for the healthy development of our bodies – including our brains and, of course, our sexual organs. A young person who receives puberty blockers and then cross-sex hormones and surgeries may not only end up infertile but may also sacrifice his or her future sexual function and responsiveness.

For a biological female taking testosterone, removing her uterus and ovaries may become medically necessary as testosterone can seriously damage these organs and cause significant pain. One consequence is permanent infertility.

The risks from cross-sex hormones alone include infertility, blood clots, hypertension, heart disease, cardiovascular disease, cerebrovascular disease, weight gain, sleep apnea, central nervous system tumours, urinary problems, erectile dysfunction, type 2 diabetes, low bone mass, osteoporosis, and more.

The risks of surgeries are significant as well. There are, of course, the ordinary risks of complications and infection. There is also a risk that additional surgeries will be needed, such as to prevent a surgically constructed neo-vagina from closing (i.e. healing). The patient may also come to regret the loss of their sexual organs, fertility or the ability to breastfeed and suffer distress as a result. Such surgeries are irreversible.

Thus, it is no surprise that even progressive, trans-affirming nations have recently reversed or revised their approach to treating gender dysphoria in children. In Sweden, pediatric gender clinics stopped prescribing puberty blockers after a documentary by Mission Investigate, Sweden’s premier investigative news programme, revealed that clinics neither fully informed parents of the harmful side effects of puberty blockers and cross-sex hormones nor monitored for such effects. Sweden’s famous Karolinska Institute, which pioneered medical interventions for gender dysphoria, now only permits puberty blockers as part of controlled clinical trials.

In both Australia and New Zealand, the medical regulators of psychiatry have advised pediatric gender clinicians to first support children’s mental health needs and move only cautiously and slowly toward medicalization. Britain’s Tavistock Clinic came under intense scrutiny for too readily medicalizing minors with gender dysphoria, triggering an in-depth review of Britain’s related healthcare policies.

Minors lack the capacity to grasp the lifelong implications of such serious pharmaceutical and surgical interventions. Altering healthy young bodies this way is not medically necessary or in the interest of their long-term health. Many people who regret medically “transitioning” are asking why nobody asked tough questions but, instead, put them on a fast track to powerful drugs and life-changing surgeries. We should care about children who may end up in the same position in the future, with irreversible harm done to their bodies.

Canada has become perhaps the most “affirming” and “progressive” nation on earth when it comes to gender ideology, especially in education and healthcare. But this has largely occurred without meaningful public debate.

That debate is long past due.

John Sikkema is Director of Law and Policy for ARPA Canada.

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