Opinion | Crucial questions about gender-specific child care are not political or legal
A message from WPATH, which appears to have been addressed to Levine, says: “We have heard your feedback about the minimum age criteria. … Therefore, we have made changes to how minimum ages are presented in the documents.”
Together, these messages suggest that Levine does not understand the ethical requirements of his job.
I contacted HHS to see if something had gotten lost in translation. After all, the exhibit I was looking at contained excerpts, stripped of context and attributed only to anonymous WPATH members who were paraphrasing conversations. And the court exhibit they came from had been compiled by an expert witness critical of these treatments.
Surely a senior HHS official didn’t ask a professional group to rewrite his expert recommendations for political purposes?
Surely Levine, who is a pediatrician and a transgender woman, didn’t suggest lowering the barriers created to protect vulnerable teens from potentially lifelong complications?
Yet surely if Levine had not done these things, the administration might have come up with something more blunt than the tepid non-denial that pointed out to me in a follow-up New York Times article: “Admiral Levine shared her view with her staff that publishing the proposed lower ages for gender-transition surgeries was not supported by science or research, and could lead to a wave of attacks on the transgender community.”
The Times article also contained a new announcement, made shortly after the Levine news broke: The White House now opposes gender reassignment surgery for minors.
This is a very small response. The allegations against Levine need to be investigated, and if they are true, she needs to be replaced — not only because she will put children in danger, but also to send the message that when it comes to figuring out the right medical treatment for children, politics never comes before science.
Much of the debate on this topic focuses on the legal, political, and philosophical issues, and too little on the empirical ones that matter most. For example: Do these treatments benefit most children who receive them? If so, by how much? And if only some children benefit, how can others be identified before starting life-altering treatments like hormones and surgery?
Consider that as this story unfolded, the Supreme Court agreed to hear a challenge to Tennessee’s ban on gender-transition care for minors. This fall, the justices will gather in their robes to hear lawyers make solemn arguments, and in June or July of next year they are expected to decide whether the ban violates the 14th Amendment’s equal protection clause.
But until we have better information about how well treatments work, this doesn’t make sense. If medical interventions help children with gender dysphoria live longer, happier lives, then states should allow them because it’s the right thing to do, not because refusing them might be discriminatory. If interventions don’t help children—or don’t help enough children, and it’s not possible to reliably identify which ones benefit—then obviously children shouldn’t be harmed in the name of gender equality.
You might think these answers are already known—that, as we keep hearing, gender-transition treatments for children are “medically necessary,” “evidence-based,” and “life-saving.” But such judgments are statements of our hopes, not impartial assessments of the available research. Several European health authorities have conducted systematic reviews of the evidence for the use of puberty blockers and hormones to treat adolescent gender dysphoria, and they have all come to the same basic conclusion: There is very little knowledge about how well the treatments work.
Better evidence is urgently needed. Unfortunately, it is becoming difficult to trust the institutions tasked with collecting it.
Last week, the Economist reported that other documents revealed in the Alabama case suggest that something went wrong at WPATH itself, which allegedly commissioned evidence reviews from Johns Hopkins University and tried to interfere with the outcome. Internal communications suggest that the research should be “thoroughly scrutinized to ensure that publication does not negatively impact the broader delivery of transgender health care.” Now, assuming that’s true, I’m sure WPATH genuinely believed it was doing what was best for children with gender dysphoria. But such meddling makes it harder to figure out whether the group is right about that.
For that matter, I’m sure that nearly everyone involved in the issue believes they are doing the best thing for children, from red-state legislators who think they are saving young people from unnecessary and harmful treatment to HHS officials who think they are saving the same children from being trapped in the wrong body. But they can’t all be right. The two camps can sincerely hold such opposing views precisely because the issue is being treated as a political and legal dispute rather than as a new empirical question that we have yet to fully answer. The only way to resolve this issue is to set aside political positioning in favor of professionalism, passion in favor of reason, and opinion in favor of facts.
