Compassion for transgender

An article in the Calgary Herald raises alarm bells that youth who identify as transgender, or “gender diverse,” are not getting the help they need in a timely manner. This is causing them undue stress and suffering.

But is the “help” actually helping?

As I read the article several points jumped out at me. First this fascinating quote,

When I came out as transgender everyone supported me. I was supported by family, friends and school. But it was still hell for me.

This is extremely telling. The claim is often made (or strongly implied if not outright stated) that the mental health challenges of the queer community are somehow tied to the lack of affirmation that they receive from the rest of us. This youth’s story suggests an exact opposite reality. I would wager that the majority of kids who “come out” as transgender, gay, or any of the other identities in the queer rainbow, would likely have a story that closely resembles this young person’s. They will receive extreme support from almost everybody around them because we have been indoctrinated, time and again, that the very act of questioning or doubting is itself hateful; perhaps even “violent.” Resistance is futile.

Anything short of absolute, unequivocal support and affirmation is seen as intolerant bigotry, so is it any wonder that everybody is supportive? Hardly.

The second sentence in the quote is equally telling, “it was still hell for me.” This confirms what the best medical research tells us about these issues; the mental health challenges faced by the transgender community appear to be largely inherent in the transgender identity itself. It is hell, regardless of the drugs you take, or the surgeries you get. According to this meta-analysis of the best research on the subject,

Compared to the general population, adults who have undergone sex-reassignment surgery continue to have a higher risk of experiencing poor mental health outcomes. One study found that, compared to controls, sex-reassigned individuals were about 5 times more likely to attempt suicide and about 19 times more likely to die by suicide.

In short, making the physical changes that we think will help transgender kids doesn’t actually improve their mental health outcomes. Elsewhere in the study the authors conclude,

The scientific evidence summarized suggests we take a skeptical view toward the claim that sex-reassignment procedures provide the hoped for benefits or resolve the underlying issues that contribute to elevated mental health risks among the transgender population. While we work to stop maltreatment and misunderstanding, we should also work to study and understand whatever factors may contribute to the high rates of suicide and other psychological and behavioral health problems among the transgender population, and to think more clearly about the treatment options that are available.

In short, the science simply doesn’t support the kinds of “treatments” that are often proposed, whether puberty delaying treatments, or surgeries. In fact, as the study describes, Johns Hopkins University no longer offers sex reassignment surgery after it became clear that it was not improving the mental health outcome of patients as doctors assumed it might.

At best these “clinics” are having little or no positive effect on the kids that walk through their doors. At worst, they are causing harm by altering the human body in a manner inconsistent with natural biology and genetics. But that’s not the message in the article. It states,

The Metta Clinic was established as a pilot program in 2014 to provide transgender and gender diverse youth with access to mental health and peer support services, puberty suppressors and other hormone replacement therapy drugs.

Without that, youth are at risk for severe mental health challenges, suicide and self-harm, addiction, abuse and harassment, said Amelia Marie Newbert, president of Skipping Stone Foundation which launched the campaign to bring awareness to the issue.

Notice the “without that” claim. In the absence of various “treatments” the youth are said to be at risk for severe mental health challenges including suicide. On the contrary, the more scientifically accurate statement would read, “with or without [those treatments] youth are at risk…”

According to the best available data, the treatments have a negligible impact on the subjects in the long term. I’m sure the treatments bring a temporarily welcome reprieve shortly after they are implemented, but the study that I linked to earlier examines the effects in the long-term; such as 15 years later. And on that scale – once the initial satisfaction has had ample opportunity to intersect with real life – the results are not nearly so glamorous. There are risks to declaring victory too early.

But perhaps the most interesting aspect of the article, in my view, is the idea that puberty is “unwanted” for this young man. It was the changes to the body that (allegedly) caused so much mental distress. Hence the need for drugs.

Pardon me for pointing this out, but I’m virtually certain that the majority of kids, queer or otherwise, are not particularly keen on puberty. I know for me, personally, puberty was very “unwanted.” I wasn’t a big fan of acne. The voice cracking was embarrassing. And the more… personal… changes were uncomfortable and confusing. Not exactly the best phase of my life, on the whole.

But that’s life. And I hate to break it to any younger readers out there, but it only gets worse. Now that I’m over 40, for the life of me I cannot get rid of the spare tire around my waist whereas exercise and proper eating were far more effective about a decade ago. I’ve started using glasses to read; ask me if that is “wanted.” I’m still recovering from a rolled ankle I received before Christmas and my knees have caused me trouble for many years now.

It sucks, yes, but that’s life. Puberty is almost never “wanted” and I assure you that the changes you will face in a few more years will be just as unwanted as puberty. Perhaps more so. If these changes to your body are causing mental health issues then I strongly suggest that you see these problems for what they are; mental problems, not physical problems. If you start using drugs and surgery to deal with your mental health issues in your adolescence, instead of dealing with them as mental health issues, then that’s a bad precedent to set for how to deal with problems during the rest of your life.

As one last note, the child claims, “there are a lot of kids like me.” Exact numbers are hard to come by, but the proportion of transgender folks in the world is extremely small. So small, in fact, that the study I linked to frequently points out that quality research on the transgender phenomenon is hard to come by precisely because there are so few of them to study. And however many kids there are out there with those tendencies, the best data indicates that the majority of them will eventually outgrow their gender dysphoria. There may be a lot of kids struggling with these issues, but there are even fewer adults struggling with them.

So perhaps the fact that the waiting list is so long might be a good thing; it provides a chance for cooler heads to prevail before irreversible changes are made.