Gender Essay

CHAPTER ONE: Affirmative Care/Conversion Therapy for Children

“First, do no harm.” 

Gender dysphoria is currently defined as clinically significant distress or impairment caused by a mismatch between a person’s biological sex and their gender identity. It is – or was – a rare condition, but very real. Gender dysphoria can ruin lives. It can drive people to suicide. For some, hormone therapy and sex reassignment surgery can be a life saver. But at what age should this begin, and how do you tell if a child or teen needs this kind of invasive medical intervention or if they are only a rule breaker, a gender nonconformist – or maybe they are just a vulnerable kid with a lot of issues that need to be untangled. 

Surgery and hormone intervention should be a last resort. If someone can grow up to be happy and productive in their own skin without medical treatment that has life-changing consequences, this is a better outcome than surgery, possible loss of fertility, and lifelong hormone treatment. We should encourage children to be explorers in whatever directions their heart takes them, whether it’s in gender expression, gender identities, role models, careers. Affirmative care should mean affirming children’s innate curiosity, not limiting it to one direction – just the opposite, we should encourage them to check out every possibility. We should encourage them to understand that they can be and do anything – and they can do this most effectively in their own healthy bodies, whatever sex they are, whatever their gender identity might be. 

The background here is a history of medical abuse related to gender issues: brutal conversion regimes for homosexuals, lobotomies for depressed or rebellious women (and men – but especially women), horrific things done in the name of “normalizing” Intersex (DSD) people, and trans people shamed, ridiculed and denied medical care. The long history of homophobic abuse and conversion therapy has made us anxious not to repeat the same mistakes with trans people, rightly so. 

But the move to pass laws that equate gay conversion therapy with gender identity therapy is profoundly mistaken. Sexual orientation and gender identity are two entirely different things. Homosexuality is not a disease or a disorder of any kind. There’s nothing to be cured. There is no reason for therapy of any kind. On top of that, sexual preference is generally fixed and unchangeable throughout a person’s life. Gay conversion therapy is not therapy at all. It’s a human rights abuse. It involves cruelty, assault and rape, because it is a desperate attempt to change the unchangeable. 

Gender identity is much more fluid than sexual preference. Many young people spontaneously change their gender identities, especially as they go through puberty. Transgender identity does not always come with serious distress or impairment, but when it does, there is a genuine need for therapy – ethical therapy that helps the patient to explore their dysphoria, along with any other issues that may be impacting them, such as their family situation or other medical conditions, and then in the context of this investigation, to help them to objectively assess the possibility that hormone therapy and sex reassignment surgery could be useful in dealing with their problems – or not. This type of critical engagement is now labelled as conversion therapy and has been made illegal in a growing number of states and countries  – but it is not remotely the same as gay conversion therapy. 

However, gay conversion therapy is still alive and kicking in the modern world. It’s happening in fundamentalist countries out in the open and it’s flying under the radar in the West. In Iran, homosexuality is a crime punishable by death, but sex reassignment surgery is legal and state subsidised. If you don’t want to be imprisoned or executed for same sex attraction, you can choose to have a sex change operation. The theory is: if you can’t change the mind to fit the body, change the body to fit the mind. 

In the West, homophobia has been driven underground, but it’s far from dead. A child can internalise homophobic bullying, and in some cases this can be a motivator for wanting to transition. Parents can support or even push their kids in the direction of sex reassignment surgery because of their own homophobia. This is not made up. There are parents online admitting this and even bragging about it. It’s the same logic as conversion “therapy” in Iran: if you can’t change the mind to fit the body, change the body to fit the mind. 

There are times when this logic must be applied, not for bigoted or ideological reasons, but because it’s the right thing to do. When gender dysphoria is persistent and intense, when the mismatch between a person’s gender identity and their biological sex is seriously impairing their life, it would be unethical not to consider medical transition. But it would also be unethical to fail to consider the possibility of changing the mind first. 

There are other issues that should also be explored in any ethical therapy for gender dysphoria. Transgender individuals, compared to cis gendered, are statistically more likely to have ADHD, bipolar disorder, depression, learning disorder, OCD, and schizophrenia. Gender dysphoria happens in the context of a confusing, cruel and sexist world. Therapy must not consider the individual in isolation, but in the context of the world around them and how it impacts on them. 

The importance of this is laid out starkly when considering the exponential explosion of teen girls applying for transition. It beggars belief that this is all down to increased availability of transition. The claim is made, “But trans people are even more oppressed than gay women, so why would anyone want to transition unless it were the only choice?” Why? Because patriarchy, because rape culture, because the pornification society and the way it comes crashing down on teenage girls especially, but also on boys. Despite the important gains made in the past fifty years of struggles for women’s liberation, in some ways, modern culture now is more sexist than ever. 

None of these issues should be used as an excuse to block transition or any other form of medical intervention, but all of them should be investigated as a part of any ethical therapy. Gender dysphoria is real. It’s serious. It can be life threatening, and sometimes the best or even the only possible treatment is physical transition. But cross sex hormones and sex reassignment surgery have serious consequences that can include sterility, loss of sexual function, long term health problems and lifelong dependency on the drug companies. This type of medical intervention should not be undertaken without serious, critical investigation. Especially where children and young teens are concerned, one-size-fits-all affirmative care is just not good enough.

Whatever gender identity is, whatever gender dysphoria is, at whatever age it appears, whatever methods are best for treating it… these are all up for debate, evidence based debate. The goal – a strong healthy mind and a body that is not chopped up into pieces, a body that does not have major biological systems disrupted by chemicals – this is not up for debate. There may be good reasons for compromise. The body is a complicated system, embedded in a complicated world. Trade-offs have to be made. Therapy often has to settle for second best. But the goal itself is not negotiable. Therapy aimed at any other goal is, fundamentally, conversion therapy.

<– Introduction ***** Chapter Two –>

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