Party politics aside, what are the debates here?
Medical care and the ‘social contagion’ theory
I’m concerned about the huge explosion in young women wishing to transition and also about the increasing numbers who seem to be detransitioning (returning to their original sex), because they regret taking steps that have, in some cases, altered their bodies irrevocably, and taken away their fertility.
In 2018, the academic journal PLOS One published a study that hypothesized the existence of “rapid-onset gender dysphoria,” a condition that causes children to suddenly identify as transgender because of peer influence. This conception of trans identity as a “social contagion” has been embraced most prominently by Abigail Shrier, a writer for The Wall Street Journal, and J.K. Rowling, who has likened gender-affirmative medical care to “a new kind of conversion therapy.”
But the study, which PLOS One corrected and apologized for, was sharply criticized as methodologically flawed and ideologically motivated, and the condition is not a term recognized by any major professional association. The number of people identifying as transgender has increased in recent years — to 1.8 percent for Generation Z, up from 1.2 percent for millennials — but many researchers say the rise reflects the growing awareness of transgender identity, both in society at large and within the medical profession, as well as greater access to care.
No one denies, however, that some people reverse their transition, or “de-transition,” for a variety of reasons. Estimates for the proportion of people who de-transition range from less than 0.5 percent to as high as 13 percent. (The numbers may vary depending on the kind of transition, which may or may not involve puberty blockers, cross-sex hormones or surgery, the last option almost always restricted to adults.)
Not all or even most de-transition stories are unhappy, as Dr. Jack Turban, a fellow in child and adolescent psychiatry at the Stanford University School of Medicine, has explained. But a small number of people who de-transition do have regrets. In Britain, a legal fight over whether minors could meaningfully consent to puberty blockers revolved around the story of Keira Bell, who began her medical transition at 16 and had a double mastectomy at 20 only to realize later that she wasn’t trans. “I was an unhappy girl who needed help,” she writes in Persuasion. “Instead, I was treated like an experiment.”
People disagree about how to balance the well-documented benefits of gender-affirmative care with the risks of medical intervention. Some experts, for example, have expressed concern that puberty blockers are not as medically benign as they are sometimes described: In some cases, they may limit options for gender-affirming surgery or cause severe skeletal problems when taken for several years, which can occur when children start puberty at a very young age.
But banning gender-affirmative care, as Arkansas has done, is a move that medical experts say will do profound harm. When trans children receive gender-affirming health care, it lowers their risk of self-harm, depression and suicide, which 30 percent to 51 percent of trans adolescents attempt.