The argument: The argument against treating minors boils down to “Kids are too young to know what’s best for them, so we should hold off making irreversible decisions until they’re adults. We should also wait until there’s more research showing gender-affirming care is safe and effective.” There’s also a fair amount of “They just think they’re trans because they saw it on TikTok / It’s the latest fad but they’ll grow out of it / Social contagion / They’re being influenced by the trans illuminati” thrown in.
The reality: It’s obviously true that kids, and especially younger kids, need guardrails to prevent them from making decisions that they’ll later regret. And while most studies show gender-affirming care is both effective and relatively safe it’s still fairly new, and pretty much every parent of a trans kid and every doctor that treats them would love to see more research on the subject. That’s why the World Professional Association of Transgender Health, Endocrine Society and American Academy of Pediatrics all recommend having a multidisciplinary care team of experts to help both kids and their caregivers to figure out what kind of gender-affirming care (if any) is right for them, with an emphasis on reversible interventions for younger children and recognition that the gender trajectories for children and adolescents may evolve over time.
But it’s important to remember that when it comes to transgender adolescents it eventually becomes impossible to avoid “irreversible” decisions. Trans adolescents have the opportunity to choose which secondary sexual characteristics they want to develop, either by starting hormone therapy or by letting their natal hormones take their course. But they can’t take no choice. Trans youth are also at increased risk for mental health issues, substance use, becoming victims of physical violence, homelessness and suicide — one study found transgender teens attempt suicide over seven times more often than their cisgender counterparts. It’s a mixed bag how much this distress comes from gender incongruence and how much comes from having to fend of constant prejudice and lack of acceptance, but it’s clear that for many trans teens the need to be their true self is literally as important as life itself. It’s not something that can simply be ignored. It’s also notable that gender-affirming care is provided to cisgender minors without any controversy at all. Boys with gynecomastia (man boobs) can get breast reduction surgery without controversy. Same with hormone replacement therapy for girls with PCOS. Blockers have been used for decades to delay precocious puberty. And no one bats an eye when a girl undergoing chemo wears a wig or a skinny boy lifts weights to build up his upper body. It’s only when a person’s gender identity doesn’t match their genitalia that it suddenly becomes an issue.
The last point argues that gender incongruence is at least partially caused by some combination of peer pressure, fad and/or social contagion, and that this explains the recent rise in young people who self-report as transgender (particularly female-to-male). While the idea that kids are choosing to be vilified by literally the most powerful men in the country and to constantly worry about being physically assaulted in public restrooms “because it’s cool” is laughable, the more general idea of social contagion has a certain logic to it. After all, the thinking goes, how could someone identify as transgender if they’ve never heard the word or had the concept explained? Fair enough, and certainly transgender adults often report having had vague feelings of gender dysphoria at a young age but not having the vocabulary to describe it until they got older. But the strong implication of the social contagion argument is not that more people whose gender identity doesn’t align with their natal sex now have the vocabulary to talk about it, but rather that if these vulnerable kids were not exposed to this “radical gender ideology” then they would grow up to be happy healthy cisgendered adults.
As Elon Musk would say “concerning if true”, but there’s simply no evidence in favor of the social contagion argument and a good bit of evidence against it. The 2018 paper that sparked the idea of a new type of “rapid onset gender dysphoria” caused by social media was based entirely on parent surveys solicited from trans-skeptical discussion groups, and has been widely criticized for its methodology. In particular, its primary evidence for social contagion is that parents often reported that multiple people in their kid’s friend group came out at trans around the same time — which honestly sounds a lot like claiming cancer support groups cause cancer. On the other hand, there is a good deal of evidence that gender identity is innate, though it’s not a completely settled matter. Transgender and non-binary people often remember feeling gender dysphoria even when they were very young, long before they had the vocabulary or concepts to understand it. Transgender individuals have also existed since ancient times and in all parts of the world with no indication of social contagion — is it really so likely that we have only now discovered a brand new way that it can spread? Both twin studies and brain scans show a strong biological component to gender identity, whether or not it matches natal sex.
How it’s being weaponized: Trump’s executive order banning gender-affirming care is already literally killing children who would rather die than detransition. But as bad as this immediate effect is, the idea of social contagion is potentially even more insidious, because once you accept that simply talking about gender identity can cause irreparable harm to children the next logical step is to stamp out any mentions of it at all. The administration is already already doing just that in the razing of government websites, and is pressuring private universities and other institutions to do the same. It’s also laying the legal groundwork to go into the classroom itself, claiming that K-12 teachers who support students who are questioning their gender are guilty of practicing medicine without a license and instructing the Attorney General to file “appropriate actions”.