Last week, the Los Angeles Times ran an Op/Ed about transgender children by Eric Vilain and J. Michael Bailey. In that piece, they question whether parents should be advised to allow transgender and gender variant children a different gender expression. They argue there is a lack of scientific evidence indicating whether it is harmful or helpful to encourage gender variant behavior.
Bailey is a psychologist and Vilain a physician and I suppose we can respect their treating this as a Hippocratic issue. “Do no harm” is a guiding principle for healers, as is reliance on scientific findings to guide treatment.
And they are correct that scientific outcomes are hard to come by. Complex factors influence the well-being of children. The scientific method, requiring a control group for every variable measured, resists application here. It is hard to measure or even define whether a child has been fully allowed to express their identified gender. Also, the variable in this case, the long-term welfare of a child in life, does not lend itself to double-blind trials or laboratory studies. It is affected by the specifics of parent/child relationships, a constantly shifting community culture, and the presence of peer and institutional support. Add this to the newness of the field, and the absence of scientific study is understandable.
That absence should lead to caution when advising parents to support gender-variant behavior, right?
Whether someone is “allowed” to live as their gender is not a question of medical treatment backed by scientific findings. It is a question of freedom.
Gender expression is as much a right as any other expression. The notion of relying on scientific evidence to determine whether freedom of speech is healthy or unhealthy would be patently absurd. Did we consult doctors and scientists to figure out whether women should vote or children attend racially integrated schools? If scientific evidence showed us that religious observance had negative health effects, or that people lived longer in places without free press, would we take away those rights?
Of course not. The principle of liberty — that people know what’s good for them and should be permitted to do it unless it harms others — is not subject to a doctor’s orders. Expressing gender is not a medical treatment. It is a basic right.
The scientific method is the go-to strategy for answering factual questions about the nature of the world. However it not an appropriate determiner of human freedom.
Our problem began when the question of whether transition was “good” or “bad” was handed over to doctors in the first place. We owe gratitude to Harry Benjamin for using his prominence to advocate for the benefits of transition, and I suppose we should celebrate his guidelines as instrumental in allowing transition-related medical treatments. They gave doctors and psychologists comfort that those treatments were beneficial. But he did not invent gender transition. Transgender people were transitioning long before Dr. Benjamin’s great grandparents were conceived.
The publication of the L.A. Times article shows that we still gladly accept doctors and psychologists not just as therapeutic advisors, but as arbiters of liberty. They have stepped beyond the bounds of their roles of determining how to administer medications safely and developing and performing beneficial surgical procedures. We allow them to tell us whether and in what circumstances an alternate gender presentation is acceptable and merits their help.
This arose because medical care is often essential for a satisfactory transition. Doctors play vital roles in helping transgender and gender variant people live well-adjusted lives. They make sure hormones and other medications don’t threaten our health. They perform surgical procedures that relieve our dysphoria and help us be whole and functioning members of our gender. They offer counseling on whether, when, and how best to achieve a satisfactory transition. The importance of medical care still holds true. Children permitted puberty blockers have a much easier time physically presenting as their identified gender. Reality is that a convincing presentation smooths the way for acceptance.
However, the problem comes when those doctors declare themselves qualified to weigh in on how other human beings should be permitted to express themselves. To declare oneself competent to do so is not just the height of arrogance, it is an attempt to place oneself as arbiter of another’s liberty. True, Bailey and Vilain were talking about children. But children, too, have rights. A doctor who questioned whether children have a right to health care or to be free from violence or degrading punishment would never be accorded space in a major news publication. Neither should doctors who question a child’s right to express gender.
This will continue until we, as a community, do something to change it. In the meantime, the youngest and most vulnerable among us will be harmed. We need to speak with a strong voice against the medicalization of rights. We need to denounce doctors and scientists (or any other people) who try to make freedom subject to scientific validation. The English language has a word for a system where liberty is conditional.