Why I don’t think minors should medically transition

Hi, this month the cover of National Geographic, one of the covers, is a 9 year old trans girl who has been socially transitioned since the age of 4 and that was upsetting to me on a number of levels. First of all because National Geographic is a magazine that mostly is associated with showing exotic animals to people and National Geographic is a magazine that has a really, really bad track record historically with presenting people as exotic spectacles. And you know I think that as a magazine they’ve made an effort not to do that as much but I don’t think it’s particularly progressive or accepting to put a trans kid on the cover of National Geographic.

You know, one of the things that I experienced while I was trans is that it was really hard for other people to remember about me that I was a full human being and that this wasn’t some kind of spectacle, some kind of stunt, some kind of entertainment thing. And um mostly the people who I experienced treating me as like, I don’t know, some kind of circus act were people who considered themselves trans allies and I think you can see all the time how trans allies in both how they talk about trans people and how they present them visually that they on some level don’t really believe that people who experience gender dysphoria are full human beings. That we can think things through, that we want the same things out of life, that we’re motivated by the same things they are. So that was one of the things I hated about being trans, there were lots of things I hated about being trans, but one of the things I hated was being treated as a spectacle. And so I don’t think that putting a little kid on the cover of National Geographic is somehow a demonstration of progressive acceptance. I think it’s creepy and weird.

But ok, all that being said, and I’m not even gonna talk about the parental decision to put your kid’s shit blast like that, to put your kid on the cover of a magazine like that. There’s so much to say about that but I am not gonna do that right now. I wanted to talk about why I so strongly feel that people under 18 should not be empowered to make these medical decisions. Now at the base level, I don’t think they should be empowered because I got that shit wrong at 30, so if I could be 30 and think that my best life was a trans guy who has to get his ass to the doctor every 6 months, and then come to understand that on so many levels that life didn’t work for me and on so many levels that life caused its own problems for me and just worsened my anxiety and put me in social situations that were not ok, on so many levels that life didn’t work for me, if I could get it wrong at 30, I’m not the smartest kid on the block, like I got my own problems, if I could get it wrong at 30 a 9 year old for sure can get it wrong. A 13 year old for sure can get it wrong. Absolutely I think an 18 year old can get it wrong but the thing about 18 is that that’s the age that we let you go off to war. So I guess that’s the age that we accept that that’s when you get to start making real decisions about the unsafe circumstances you want to put your body through.

Ok. A lot has been said by other people about how incorrect and troubling the idea that kids’ gender identities are somehow stable is. There’s a lot of research out there that actually lots and lots of kids feel strongly that they have a transgender identity and then going through puberty they stop believing that. I’m not going to talk about that angle actually. For this video I just want to use the framework that indeed Avery on the cover of National Geographic knows herself and this gender identity that she has been supported and affirmed in since the age of 4 is stable and not the result of socialization and this is not a social system thing, for this video, even though I don’t actually believe this, I think you can see all kinds of social systems feeding into the affirmation of this identity, but for this video I want to work with the framework that Avery knows herself. And that this trans identity is going to be permanent and stable and the best life for Avery is one in which she gets to occupy the social role of woman. And another framework that I’m going to use for this video is the idea that the way that this affects Avery’s fertility, let’s just for this video use the framework that Avery also knows herself very very well in terms of what she’s going to want in terms of parenthood in the future.

Puberty blockers, what the leaders of developing this puberty blocking protocol for kids with gender dysphoria recommend is that you don’t start the puberty blockers until Tanner stage 2 and 3 that will give you a chance to harvest eggs and sperm. And if someone has the money to pay for this, in these equations I never know who people think are paying for this, but then that child can both medically transition and have those sperm and eggs banked, so that when they’re 20,30,40 they can choose to be biological parents. That seems to be the recommendation but I keep seeing articles about 9 year olds being started on puberty blockers, which…like 9 year olds are already at Tanner stage 2, like I know precocious puberty is a trending, troubling thing but like it seems like actually what’s happening is that kids are not even being given the chance to Tanner stage 2 before they are put on puberty blockers, which is awful.

But for the framework of this video, let’s just assume Avery is this super wise kid when it comes to her own gender identity and this super wise kid when it comes to her own future with fertility, because I see other people making those critiques and that’s not the critique I want to make. Using the framework that we are going to buy into the idea that a 9 year old knows herself very deeply on those two levels I’ll tell you what that 9 year old does not understand. That 9 year old does not understand economics and and doctor’s appointments. Ok?

When I was 30 and I believed I had a trans identity I thought that I understood what it meant to sign up for a life where you gotta get to the doctor every 6 months. I thought I totally got it. It wasn’t until I worked at that clinic that I realized that I didn’t get it at all and that it seemed that lots of members of my generation didn’t really get it until we had already gone far enough along in the process that we were in it whether we understood it or not. When you put a kid on puberty blockers and then you put them on cross sex hormones that damages their endocrine system permanently. And so what that means is that for the rest of that child’s life they will have to have a life long relationship with their endocrinologist and they will have to get to the doctor twice yearly.

That’s if there are no complications and we don’t know what complications are likely for kids who do puberty blocking and then cross sex hormones because there are none, there is not one study that follows up with these kids. That study has partly not been done because those kids haven’t gotten there yet. This generation of kids has not made it to their twenties yet. And when that first study comes out what that study is going to look like is just following up with kids in their twenties and asking them about health outcomes. So that’s a pretty experimental thing to put a kid through.

And the thing about GnRH agonists, which are what puberty blocking drugs are, they weren’t developed for kids, they were developed for adults and specifically for adult conditions where it would be helpful to have your hormonal system pretty much turned off, is that there are adults out there who really regret taking GnRH agonists. If you google “lupron” you will very quickly come to lupron victims hub which is a website run by a woman who took lupron as part of IVF therapy in the 80’s or 90’s and documents cases where people strongly suspect that taking GnRH agonists have given them long term health consequences. So these are not a class of drugs that are without controversy in adult patients.

When I was working at the clinic what I realized is that just for exogenous testosterone use doctors are not, the ideas that doctors have about the care that is appropriate for patients, are not coming from medical literature. So if you have a complication, like vaginal prolapse and it comes from, it has happened because of your testosterone use, there is medical literature on vaginal prolapse, your doctor will use that to treat you, there is not any medical literature about patients who are taking transition levels of testosterone and vaginal prolapse. So your doctor is working from medical literature that is not really about patients like you, so your doctor is kind of filling in the gaps with their own knowledge and you know it seems like a lot of doctors who do trans care feel confident about filling in those gaps just from kind of like their anecdotal experience treating trans patients. As a patient and as someone whose body I have put through some medical intervention, I don’t think that that’s good enough.

After working at that clinic I was really upset at myself for not respecting my body more in terms of demanding that the medical interventions I put it through had been found safe through research. And you know, I had the idea that my body was wrong, that it was disgusting, that it was incorrect and that it kept people from seeing the real me, and so I think on some level I just believed, I just felt like kind of a hostility towards my body and so I didn’t really care. I didn’t care if like…I didn’t care to know what the rates of ovarian cancer were, I didn’t care to know what the rates of stroke were. I think on some level I felt like my body was my enemy. But once I saw that disrespect reflected in medical professionals for the bodies of people who experience gender dysphoria than I got pissed.

If you look at the relationship between people with gender dysphoria and doctors what you’ll see through the history is that doctors are very willing to do experiments on us. And that’s very normalized for us. There’s the film “The Danish Girl” which is about a doctor doing an experiment on a trans woman, or doing a surgery that the doctor knows full well has killed other people, and going ahead and doing that on her, because I guess her desperation justified him doing a surgery he knew would kill her.

There’s a website that just recently got created out of Toronto which is to encourage primary care doctors to feel confident prescribing hormones for gender transition and I think the idea is that primary care doctors are less expensive and thus more accessible to more people and that’s why there’s this push to have them prescribing the hormones. I really think that you should go to someone who really knows the endocrine system, I think that this is specialty care and you should see an endocrinologist, but so, I think the motivation behind this website is suspect already, but it’s interesting because if you go look through what this website has about the complications from testosterone use this website says about ovarian cancer that there have been studies that have found that women whose bodies just naturally produce more testosterone have higher rates of ovarian cancer, but there have been no studies linking transition levels of testosterone and ovarian cancer, because no one’s bothered to do the study. It’s one thing to say, “hey we did a study looking at whether people who used testosterone to transition get more ovarian cancer and we didn’t see a link,” that’s one thing. It’s another thing to say there isn’t a link when no one has bothered to do the study. And it makes sense that no one has bothered to do the study because who has the incentive to do the study?

Pharmaceutical companies, they didn’t make these hormones with the idea that people would transition genders with them, this is an off-label use, and then you have this highly motivated population that wants to do the interventions regardless of cancer rates and stroke rates and prolapse rates. But I’ll tell you what when those complications are a possibility it might be worth it to you, when those complications are a reality in your life you might feel way differently about things.

And I feel really, really blessed to have gotten to work at that clinic and seen, and be given the chance to see complications and to see how very difficult to manage those complications as a patient, because if I hadn’t been given that opportunity it wouldn’t have been real to me that I didn’t actually want to be on the receiving end of medical interventions that don’t have a body of literature that tells doctors how to do this safely and how to treat complications resulting from it. I think that doctors in trans care act way more confident than they have any reason to act confident about these things. So that was the understanding I came to about my own feelings about what my body deserved, and I feel that this body that I’m in deserves medical care that is substantiated by literature, and I do feel like that is more important to me than anything about an identity that other people affirm. All that stuff is secondary to my body like getting medical care that is safe and well researched. I’m not trying to be a danish girl over here. I am not.

So if I could discover in my thirties that actually my standards of medical care that I was on the receiving end for were more important to me than having an identity affirmed, how would a 9 year old over come to that realization? How does a 9 year old, does a 9 year old understand that in the normal course of american adulthood it’s super normal for people to not be able to get to the doctor for years because they don’t have the money? Does a 9 year old understand that like, when we finally get to the point when these kids are in their twenties to do a study about health outcomes, that’s going to be the first time? That they are really like the first class of doing this experiment? I don’t know, what if that 9 year old gets to their twenties and they’re like, “oh you know what, I don’t trust doctors at all and I don’t want to see them and I really would’ve liked a life where I didn’t have to be dependent on an endocrinologist to keep living.”

This is assuming that the gender identity stays the same, it is assuming that the feelings about biological parenthood stay the same. Just because a person has gender dysphoria and just because a person is trans-identified doesn’t mean that it’s ok to try out new interventions on us. I don’t think- I think that you can clearly see in the medical system that the people who get experimented on are people who are not considered valuable. They tend to experiment on poor people, they tend to experiment on people of color, they tend to experiment on female people, and so honestly I see this push for pediatric medical transition as just another instance that shows, much like us being featured on the cover of National Geographic, how much people with gender dysphoria are really seen as not fully human. Because I don’t think that you would just do this to a kid that you really saw as a full person, who had a right to as much of an adulthood as other people get.

One of the things about being dependent on your doctor to make your endocrine system work is that it really limits your ability to travel. Because you gotta get back to your doctor every 6 months, you gotta. And when I was working at the clinic that was a thing that man, lots of people who had not come to terms with the fact that they had chosen a life that limited their ability to travel. It was really hard for people, it was really hard for people to understand that no, it’s not that simple to call in a prescription to England, it’s not that simple to tell you what clinics to go to across Europe, like, you know you signed up for a life where you gotta have consistent medical care, and generally that life is lot more sedentary and a lot more tied to making good money and making sure that you have medical access than other people’s lives.

And I got an email from someone who really wanted to transition because they really want to travel all over the world and have adventures, and they perceived that that is safer and easier for men, so they wanted to be a man. Here’s the thing, maybe that is true for cis men, maybe that is a true thing for men who came into this world with an endocrine system that when it does it’s own thing gives you a beard and gives you broad shoulders, and like, I think it’s pretty true that like if you’re that kind of person and you have that kind of body then yeah, it’s safer to travel the world. You don’t get that body when you transition, what you get is a body that has to go to the doctor all the time to give you that beard and give you the broad shoulders and the same substance that is giving you the beard and giving you the broad shoulders is also changing the chemical composition that all your organs are dealing with, and no one has done studies on how, generally, our organs react to that. And so, sure, if you’re a cis guy things might be easier in terms of world travel, being trans and world travelling don’t go together. Like, I’m not saying it’s pick one or the other, but I’m saying if you choose one the other becomes much harder. It’s not just about money and funding travel anymore, it’s about how are you going to get your blood tested, who’s gonna prescribe the hormones? And that’s the kind of logistical thing that really ends up limiting people’s lives and it’s the kind of logistical thing that adults who make these decisions don’t consider until they’re in it, so I know for sure that like a 9 year old can’t consider that stuff.

So that’s why I don’t think that people under 18 should make these decisions. I don’t think I got it at 30, I wish that everyone thinking about these decisions could go spend a half a year working at a clinic for trans people, I think that people would have a much better sense of what they were signing up for if they did that. But if we can’t do that for people then we can at least say that you gotta be a legal adult before you make these big decisions.

Ok, well that’s it, take care of yourself, take care of your kids, keep them off the cover of National Geographic, don’t, don’t do this thing where like, if you have a trans kid you put them on blast, you make it a big part of your identity that you have a trans kid. Get your own shit, do something for yourself that you can be proud of, it’s weird to like make the fact that you had a trans kid the most important thing about you, ugh, like seriously, get some self esteem. Bye.