Wrestling With Gender Dysphoria

Wrestling With Gender Dysphoria

By

Leonard Zwelling

https://www.nytimes.com/2024/12/08/opinion/tennessee-trans-supreme-court-case.html

David French did as good a job as I can imagine outlining the key issues surrounding the gender identification case that was argued before the Supreme Court, United States v. Skrmetti. The case involves a law in Tennessee that bans the use of puberty blockers and other such drugs on minors who identify as transgender.

My understanding of a transgender person is someone who is born with a set of chromosomes that determines he or she is of one sex, but feels like he or she is of the sex inconsistent with that determined by those chromosomes. In other words, it is an XX person who believes “she” is a male or an XY person who believes that “he” is a female. Let’s leave out the non-XX or- XY folks for right now.

As French points out, he cannot imagine a more distressing state of mind than that of someone whose body does not match his/her felt gender. Forget about the furor over pronouns and let’s keep this discussion on a clinical level and leave the sociology for another time.

I too have struggled with what to do to help these people without hurting them. But as French says, this law is about minors only and it is basically saying that waiting to do anything about reassigning someone’s gender might be the best course of action.

I have a little different take, but not one that lends any clarity to the issue.

As I understand it, the actual medical evidence for the use of puberty blockers in putative transgender teenagers is slim to none as to whether they help. It is not slim with regard to the drugs’ significant side effects. Taking a male body and treating it with female hormones or taking a female body and treating it with male hormones is very consequential. It does affect the rest of the person’s life. It is also surely true that young people can feel one way one day and differently the next such that subjecting them to treatments that alter their bodies permanently must be done with great thought and physical and psychological evaluations. Even parental consent is not fail-safe either way. A parent could easily be swayed with regard to the use of puberty blockers on their child.

So, what’s the right thing to do especially when it really isn’t clear what expert opinion even is?

There can be no doubt that someone over 18 is fully capable and should be allowed to make the decision about which gender he or she (or they) will live as. It is less clear that a twelve-year-old is ready to make such a decision even as he or she can rightly feel trapped in the wrong body.

The obvious answer is that more research needs to be done to determine the benefits and risks of puberty blockers in adolescents. The rhetoric on both sides, to allow the use of these drugs or against their use, is plentiful. The data are less so.

I don’t even know where the “do no harm” position is.

One day in the Legacy Community Health men’s room, I walked in to find a woman in front of the mirror applying her make-up. Startled, I walked out quickly thinking I had entered the wrong bathroom. I had not and everything dawned on me. But that person was of age and able to make that decision.

Perhaps the Tennessee law is not so crazy after all. If there are insufficient data to make these decisions, and parents may not be the best arbiters for their own children’s medical care, maybe the state needs to step in to protect them. But in so doing, the state may be relegating some teenagers to a life of real misery trapped in the wrong body.

This is among the most difficult of medical decisions before us today.