A transgender ideology of harm minimisation

“It often happens that science arrives eventually at a truth which common-sense has discovered without its aid a long time before.” - GK Chesterton

The World Health Organisation’s definition of health is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. That is, WHO asserts that physical and mental well-being is a human right, enabling a life without limitation or restriction. Consequently, endangering a person’s mental health is a violation of a person’s human rights. This includes childhood emotional neglect.

I recently blogged a response to ContraPoints’ YouTube video “Transtrenders”. Towards the end of the video, transmedicalist Tiffany Tumbles conceded defeat to her friend Justine in a Socratic debate about what justifies the existence of transgender people. Tiffany freaks out and says, “We have no theory Justine. What do we do now? How do we prove we’re valid?”

I’ve thought a lot about this debate, and I’ve come up with a total of two theories for Tiffany to console in (yes, this makes me a trans ideologue): the human biological sex spectrum and the harm minimisation approach. Bio sex is made up of:

1. Chromosomes

2. Gonads

3. Genitalia

4. Hormones

5. Secondary sex characteristics.

Chromosomes can’t be manipulated, unlike the other aspects which can be manipulated through trans healthcare. But even so, according to the World Health Organisation:

“Humans are born with 46 chromosomes in 23 pairs. The X and Y chromosomes determine a person’s sex. Most women are 46XX and most men are 46XY. Research suggests, however, that in a few births per thousand some individuals will be born with a single sex chromosome (45X or 45Y) (sex monosomies) and some with three or more sex chromosomes (47XXX, 47XYY or 47XXY, etc.) (sex polysomies). In addition, some males are born 46XX due to the translocation of a tiny section of the sex determining region of the Y chromosome. Similarly some females are also born 46XY due to mutations in the Y chromosome. Clearly, there are not only females who are XX and males who are XY, but rather, there is a range of chromosome complements, hormone balances, and phenotypic variations that determine sex.”

In other words, nothing in biology is a dichotomy; everything is a spectrum. However, people confuse genotypes and phenotypes, giving rise to a perspective on genetics that is eugenics/Galton-style in understanding.

Since gender (phenotype) is the manifestation of sex (genotype), there should be no surprise that transgender people have existed throughout human history. So what? The ‘so what’ is that at the end of the day, we’re all just people trying to get through life the best we can before we drop dead. Life is brutiful, and deep down, we just want to minimise harm to ourselves and others. So there’s your theory Tiffany: the harm minimisation approach. I think that’s what your friend Justine was trying to convey to you, albeit poorly.

I’ve previously blogged about transgender science and medicine in detail, but it’s only a wet dream for transmedicalists: https://medium.com/@danapham.au/gender-wars-what-gender-wars-9ac917a5eeeb. I now consider myself a trans harm minimalist — it’s common sense to minimise harm, so what does that look like? A few things come to mind:

1. It is the role of the psychologist/psychiatrist to figure out if a trans patient has comorbidity, and if the patient does, ensure the patient’s condition/s are well managed, and not driving apparent gender dysphoria, especially if the dysphoria is not insistent, persistent and consistent. If your / your child’s psych is not doing this, go find another psych. We don’t need more detransitions happening.

2. What’s the ‘right age’ for a trans child to start puberty blockers? What’s the ‘right age’ for that child to start hormone replacement therapy post-puberty blocking? It depends on how bad the dysphoria is for the child, and for which part of their developing bio sex. No two cases of gender dysphoria are the same, and rigidly standardising trans healthcare is harmful. If in doubt, ask yourself, what course of action will cause the least amount of mental health harm? Also, consult the Australian Standards of Care and Treatment Guidelines.

3. Despite the hysteria you see in the media, puberty blockers are not administered before puberty hits. Common sense right? And if puberty blockers are that bad, why is nobody complaining about children experiencing precocious puberty receiving the same blockers? All medical treatments have their benefits and risks, even Panadol, which is so easily available and accessible. Perhaps we should get hysterical about Panadol?

4. Secondary sex characteristics are a manifestation of hormones, especially during puberty. I’m very blessed that my East Asian genetics didn’t masculinise me badly during my male puberty, but other trans girls haven’t been so lucky. Surgeries to manipulate secondary sex characteristics like facial feminisation surgery are painful and expensive. Again, I’ve been very fortunate to be able to pass in society as a woman without needing such surgeries, despite lack of access to puberty blockers growing up.

5. Passing isn’t about superficial looks. Passing, for transwomen, is about getting on with life in society as women without people reading you as men. Passing is about long-term safety and well-being. Whilst the behaviour of the over-memed “It’s Ma’am!” transwoman is not acceptable, perhaps she wouldn’t have rose to infamy on the Internet if she was administered puberty blockers growing up in order to pass well as an adult woman. Being trans isn’t fantasy play, it’s a very serious matter.

6. What if the child wants their own biological kids later on? Fertility does not take priority over mental health. Besides, we’re all God’s children, what’s wrong with adoption or fostering?

7. Another hysterical narrative you may have seen in the media: the scary rise of trans children and adults, and the even hairier rise in detransitioners. As time goes by, more and more people in our society figure out that they’re genuinely gay, yet no one complains about that? The same principle should apply to gender transitions, unless of course if you have a problem with adults and children figuring out who they really are, and being true to themselves?

8. Unfortunately detransitions and regrets do rarely happen, and I want the very best healthcare for detransitioners, but their detransitions should not be used maximise harm against people whose gender transitions are right for them. It’s also worth mentioning that whilst some people detransition because transitioning genders wasn’t right for them, others detransitioned not because it wasn’t right for them, but because they were pressured by others to detransition.

9. Desistence can be a form of survival mode, rather than being genuine desistence. In any case, desistance stats often quoted by those who don’t support children transitioning genders refer to old studies that studied children at random from gender clinics and followed them, only to seemingly find that most aren’t trans when they grow up. Some of these children had a gender dysphoria diagnosis, some just simply identifed as trans, and some didn’t even identify as trans at all. Of course in these studies where many children apparently naturally outgrew their gender dysphoria by adulthood, they were clearly not suitable candidates for gender transition to begin with.

I see testing for gender dysphoria as a spectrum of sorts, where at one extreme is very subjective gender self-identification, and at the other end is a brain scan you could trust as much as an x-ray of a broken leg (neuroscience isn’t there, yet). Somewhere in the middle is gatekeeping, which is less subjective than self-id, but isn’t entirely free of subjectivity. I don’t think playing in this spectrum is useful, again I’d prefer a harm minimisation approach.

If a child presents with gender dysphoria, ‘talk’ therapy has been tried and it doesn’t work to talk them out of it, comorbidities have been explored, they’re really miserable (may or may not experience suicidal ideation) and it’s affecting pretty much all facets of their life, what should one do? Watch them suffer and wait till they’re 18? Isn’t that cruel and unusual, and an inappropriate last resort? Transition can be baby steps, it doesn’t even need to be full blown. For all this talk about HRT and surgery, there is no one right way to transition.

I would suggest talking to the parents that have to deal with this 24/7. It’s harrowing, and it’s easy to judge them from a distance. I’m also curious to know, what would you have said to my 14 year old self?