Gender clinics, quick assessments, and cisgender girls: cue the moral panic

The Ottawa Citizen reported recently on research published in the journal Pediatrics which studied access to gender affirming care for trans youth. The journal article endorsed timely mental health support and more rapid access, but there was one statistic that made me wonder. Of the 174 participants in the journal study, 137 were assigned female at birth. This apparently reflects an internationally documented “ratio shift which now favours trans-masculine youth”.

The media have recently discovered this anomaly and are milking it like only the media can.

The CTV newsmagazine W5 aired an item October 24th which began with a happy transition story by a young trans man from Pembroke, Ontario but then moved to some less successful female-to-male transitions in the UK that made headlines there. Keira Bell, who de-transitioned back to female, took the Tavistock Centre in London to court because she claimed she underwent only a superficial series of conversations before she was supposedly encouraged to transition. The initial decision of the court supported her, saying in effect that it is highly unlikely that a young person could understand the risks and weigh the long-term consequences of puberty blockers, deeming the procedure “experimental”. The Court of Appeal eventually overturned the ruling, but the legal actions continue.

The second and primary story concerned Sinead Watson who transitioned to male in her early 20s, then de-transitioned and is now advocating against kids gaining access to hormone blockers. Naturally trans folks are a little upset with her, telling her she was never really trans, a conclusion I would have thought was obvious but which, strangely, seems to perturb her. Watson’s sob story makes for good television, but it has absolutely no value in assessing whether hormone blockers or any other physical intervention is too liberally applied. Why would the experience of a cisgender woman be relevant for a trans person? I have some sympathy for her unfortunate fate, but Watson has still not taken responsibility for decisions she made as an adult about her own life.

The flaw in the W5 piece is that it shifts its attention from Canada to the UK – one of the most transphobic countries in Western Europe – and presumes that what applies there applies here. It does not explore the depths of transphobia in the UK, and whether that has any implication upon their reporting. (I have lots to say about UK transphobia, but it will have to wait.) Canada has absolutely nothing to learn about the treatment of trans people from the UK.

The National Post also had something to say on the same topic. (The article was reprinted in the Ottawa Citizen.) Here’s the line in the piece that made me think this might be a manufactured crisis. The author, Tom Blackwell, writes of a “nascent movement calling for brakes to be placed on a health care system geared to affirming a young person’s transgender feelings with drugs and surgery, allegedly in some instances after little assessment of other psychological issues.” If you’re launching a movement, maybe you should have more evidence than “allegedly in some instances.”

Later in the piece, Howard also writes that “critics” and “opponents” worry that the bill passed recently in the House of Commons prohibiting conversion therapy could “inadvertently outlaw more careful assessment before transition.” These critics and opponents are unnamed. Perhaps it’s because it doesn’t take a lot of reflection to see how ridiculous this is. Conversion therapy is not therapy; it’s coercion. No court in this country would confuse it with an assessment done in a gender clinic. As with all things trans, there are a lot of highly dubious arguments being presented as credible concerns.

Nonetheless, the National Post also cites the opinions of trans man and registered nurse Aaron Kimberley, who runs the group Gender Dysphoria Alliance and who believes the process has become politicized; and Erica Anderson, a trans woman and senior officer with WPATH (World Professional Association for Transgender Health) who complained in an op-ed in the Washington Post that there are too many sloppy assessments and hasty decisions prescribing medical intervention.

So, what to make of all this?

At the risk of sounding like I’ve gone over to the dark side, there is undoubtedly something here that requires investigation. 137 study participants assigned female at birth out of 174 is a ratio that is seriously out of kilter. W5 statistics for the UK claimed 67% of referrals to the Tavistock Centre were assigned female at birth while in Canada the number cited by Trans Youth Can! in 10 hospital clinics was 80%. Knowing we live in a sexist and misogynistic world, that girls have always had body issues and that social network algorithms only increase their body anxieties, I don’t think it’s wise to put our heads in the sand and ignore these numbers. I realize that I’m starting to sound like J. K. Rowling, but it’s not wrong to be concerned about cisgender girls having difficulty navigating toward a female identity in a hostile world. My experience tells me, however, that people will happily throw trans kids under the bus to protect cisgender ones. You don’t have to look far to see how little trans folks are valued. This is what we need to protect against, and why we need to take this issue seriously.

Neither W5 nor the National Post gave us any useful information on whether this was happening. They gave us opinions. There were assurances from doctors and therapists that no one makes these decisions lightly, but no details on whether they are taking into consideration the unique circumstances and pressures facing those assigned female at birth. I have to believe they are, if only because they are in a difficult position. If they’re seen to hinder the transition, they’re vilified by the trans community. If they make it too easy, they could be sued, as they were in the UK. (The National Post story also told of a Canadian mother and daughter who considered suing.) No one likes to be in a lose-lose situation like that. Their best protection is to be thorough.

That thoroughness may seem like a needless obstacle to some trans youth, but it may also ensure that health care for trans youth is protected. What the dominant culture is demanding is 100% protection against cisgender kids making bad decisions and if they don’t get it, it will be looking for someone to blame, and that will be us.

Despite media attempts to raise a panic among the population, I’m inclined to think we’re still on the right course. Both W5 and the National Post stated that Canada is one of the most liberal countries in the world in the treatment of trans youth, implying that this was de facto proof that we’ve gone too far. We were also the fourth country in the world to legalize gay marriage, however, and we weren’t wrong there. It’s a specious point in itself, but it’s galling because it appears convincing to many people in this country with a colonial mentality: that is, we’re a nation of followers, how dare we presume to lead?

W5 asked the Tavistock Centre to comment on their story and they issued a statement saying that each young person was different and that they had no expectation of any given outcome. They added that the majority of their clients do not access hormone blockers or any other physical intervention. That last part was worth repeating because it suggested that the central issue of the W5 story was a manufactured controversy. Unfortunately, it – like the “allegedly in some instances” phrase in the National Post article – was overwhelmed by the rest of their reporting. Perhaps they were hoping no one noticed.