How much regret is enough?

A response to Lydia Polgreen

On December 1st, Lydia Polgreen published a NYT opinion piece in defense of medically transitioning children. The piece was originally entitled 'There is no way to live a life without regret'. Since then, the title has been updated to Born this way? Which way? It's a long article with a series of lyrical but disjointed arguments that all seem to serve the purpose of defending a child's right to make their own mistakes about gender transition, no matter the long-term cost.

As a believer in viewpoint diversity I support Polgreen's right to hold her position however wrongheaded I might feel it is. But I yearn for the day when, as a counterpoint, media outlets like the NYT would also publish the voices of those of us who might feel that children deserve better than to be shuffled along the path of profoundly invasive medical procedures with serious health and social consequences to themselves, their families, and the larger community.

Below I have outlined some of Polgreen's main arguments as I understand them, followed by my thoughts on each.

waiting…

Claim: People should have the freedom to make their own mistakes.

Polgreen compares regretting gender transition to her regretting her decision not to try out for her middle school swim team in sixth grade. The comparison is, in my view, clearly absurd and I'll point you to Lisa Selin Davis' essay on why. But the argument that people should be allowed to make their own mistakes has some validity. Choice matters, and making mistakes is how we learn. But mistakes come in degrees, and as a society we have entire institutions built around protecting people (adults and children) from making decisions that might harm them, or harm others. We don't let six year olds drive cars, or buy guns or alcohol. Transitioning puts children's long-term health at risk, endangers their ability to have healthy relationships in the future, including experiencing sexual pleasure. Children may make mistakes but we as adults must do our best to minimize the potential damage of those mistakes for as long as we can. That's what safeguarding is for.

Claim: Gender is like race - it seems immutable on the surface but is actually malleable and you can change your mind about it over time.

I'm unsure what this claim is seeking to prove. It's a strange comparison. You can’t actually change your skin colour or your cultural heritage any more than you can change your sex. You can renounce your cultural background or embrace another, but you cannot change your biography or the people who raised you. But more importantly, if gender (or sex) is malleable, then why are we permanently medically altering children's bodies as if it were fixed?

Claim: Gender is something that is given to a person at birth by someone else.

This is a false statement. Sex is observed at birth and often even before birth (through ultrasound) - just as it is observed in other mammals and living organisms. Gender is the social role we associate with sex.

Claim: People inherit traits like eye or hair colour; or they have bestowed on them religions, folkways or traditions by their families or communities. Some people choose to change these things.

Adults are free to change the physical traits they don't like while understanding that these are cosmetic decisions that do not substantively change who they are. Changing religion or cultural traditions do not typically endanger a person's health the way medical procedures to change one's gender presentation can. The stakes are not the same.

Claim: People let minors go for cosmetic procedures all the time and some people regret those. Gender isn't any different.

Except it is. Healthcare organizations like WPATH are calling gender-related surgeries ‘medically necessary’ based on scant evidence and are largely denying that regret happens. Families are told that if their child does not transition they will die by suicide. And people are told that they can literally change sex though no mammal ever has been observed to do so. Also, does anyone else find the argument strange? I'm not OK with children undergoing cosmetic procedures either. It seems odd to hold up these procedures as some sort of standard to aspire to?

Claim: Only a handful of people regret gender transition and the same ones are paraded over and over in the public eye.

We do not actually know how many people regret their transitions. Detransitioners are not the only ones who experience regret. I am trans and I regret my decision. I'm not alone. Few people choose to speak publicly about their regret or detransition - is it any surprise? Coming out as a detransitioner comes with the threat of being hated by the LGBTQ+ community that once embraced you, of being pitied by people who revel in calling your body ‘mutilated’, and of being mocked by people who think you’re stupid for having done this to yourself. No wonder few are willing to put themselves through that kind of public humiliation.

Claim: Medical transition does not foreclose being a parent. The effects of hormones are often reversible.

This is a very misleading statement. Youth who undergo medical treatments (i.e. puberty blockers and cross-sex hormones) are virtually guaranteed sterility, and the younger they are the likelier that they will never experience sexual orgasm. Few people avail themselves of fertility preservation options, many of which are cost prohibitive. These procedures are being introduced at younger and younger ages to children who cannot understand what they are giving up. To read a more in-depth account of how misleading this statement is, check out Jamie Reed's post.

Claim: Only a small number of children undergo medical transition. They receive outsize attention from legislators and politicians.

By Polgreen's own admission, over 4,000 children accessed hormones/blockers in the USA in 2021 (more than double the number in 2017). That number continues to climb. These youth will very likely have to live with long-term effects on their sexual, physical and reproductive health. If children are being harmed - and they are - what would she propose we do? Be quiet about it?

Claim: Gender is contagious — for everyone.

On this point, surprisingly, we can agree. However, most of us don't require medical procedures to affirm our gender. And if it is contagious, then it cannot be innate, which undermines the oft quoted argument that trans children 'know who they are' or are 'born in the wrong body'; arguments that are used to justify medical procedures on youth.

Claim: Maybe some people are harmed but many others benefit from gender-related medical care and should not be denied it.

In mental health there is a type of cognitive distortion called all or nothing thinking. It refers to the tendency to engage in black and white reasoning when faced with an ambiguous situation. It often leads to unnecessary suffering because most things in life are not black and white. The alternative is to develop the skill of tolerating ambiguity. People can be harmed by AND benefit from a treatment AT THE SAME TIME. These truths can coexist. However, we can only start to work towards differentiating those who benefit from those who are harmed if we acknowledge that harm has occurred. That is why we need to pay attention to detransitioners and others who have been medically injured by these procedures.

Claim: Gender is an institution like arranged marriage. It’s an institution you can reject. You can choose your own life partner / gender.

This is a false comparison. Unlike the many possibilities opened up by leaving behind arranged marriage, undergoing a gender transition threatens to foreclose more life options than it creates. It can negatively impact people’s relationships with others and can complicate their relationship with their bodies and themselves. Every choice comes at some kind of cost. Giving up on arranged marriage comes at a cost to social cohesion -- a price that we as a society have collectively agreed to pay in the West for the benefit of freedom of choice. A gender transition’s cost-benefit analysis - especially for youth - is less rosy.

Claim: Queer identities used to be seen as defective until we came round to seeing them as immutable and innate (‘Gay people have no choice’). But it isn’t true. Sexual orientation isn’t fixed or binary either. Born-this-way is an old argument. Life experiences, including traumatic ones, help shape gender. You can’t make a mistake with gender because there’s no way to get it right - you can only get it right enough.

Interesting argument. Hadn’t heard that one before. But it doesn’t make sense. Sex is an observable reality that can be tested and studied in humans, mammals and other living species with remarkable accuracy. Gender, on the other hand, is culture-bound. The real question is how do we integrate those individuals into society who do not neatly fall into traditional sex roles or who express their genders in non-traditional ways?  I believe in bodily autonomy and self-determination as values worth fighting for. Safeguarding doesn’t prevent autonomy; at worst it may slow it down. I believe it's a price well worth paying. Safeguarding helps protect those who may be going down a medical path because they believe it is the solution to all their problems when it is not. I should know: I thought transition would cure my depression and anxiety because I was told as much. It didn't.

Claim: Choice is the most important gift we can give a child.

We agree to an extent on this point. But I think we disagree on what a real choice is. As adults we protect kids so that they have as many options open to them as possible. When they are adults they get to choose which direction they want to go. To put a child on blockers or cross-sex hormones is to potentially rob them of many meaningful choices - to have children, to breastfeed, to experience sexual pleasure. An analogy: A child might choose to run into traffic but most adults would not let them make that choice without trying to pull them out of the way of oncoming traffic. It's protective, not oppressive. Kids don't always know what's best. Choice isn't the most important gift to a child; love is. Sometimes love means being willing to say no.

Claim: Regret exists because we all get just one life.

Sure. But we don’t need to hasten the end of that one life for our children by putting their physical health at risk. We have social rules for safeguarding: We have roads with traffic lights because to not have them would increase confusion - and deaths -  on the road. We have building codes because if we didn’t our homes would crumble at the next earthquake. We have informed consent processes for medical procedures because if we didn’t, we couldn’t accurately weigh the risks and benefits. Regret exists but we don't need to seek out or encourage experiences that are likely to result in it, especially when talking about children. 

Final thoughts

Here’s what I believe: The issue of youth gender transition is polarized in part because real harm has occurred to individuals, families and communities. Many of the medical, governmental, and legal institutions we rely on for safeguarding have until recently failed to acknowledge the harm. The struggle continues: detransitioners are actively silenced, those of us who have regrets are not studied or followed up with, researchers are attacked for studying detransition or regret.

The status quo is unsustainable. We need a new vision for how to integrate gender diverse individuals into our societies. We need a vision that does not require sacrificing a young person's long-term health for the sake of social acceptance.

That’s the NYT article I want to see. I’ll wait.

Please send you submission, suggestions, and action alert recommendations to LGBTcouragecoalition@gmail.com