I was a girly boy. I’m relieved to see the tide finally turning on youth gender medicine

The emperor has no gender-nonconforming clothes on this one

i. i was a girly boy

Let me start here: I was a very girly boy.

I don’t know if I was history’s girliest boy. It’s possible that if you talked to some of the people who knew me back then, some of them would tell you I was just a regular boy. But here’s how I remember things: I hated sports. I thought the muscle-man stuff the entertainment industry was shoving down boys’ throats at the time (G. I. Joe, Masters of the Universe, WWF, Stallone, Schwarzenegger, etc.) was dumb and insulting. I liked cooking and sewing. I preferred to play dolls and jump rope with the girls, rather than sportsball with the boys. When I first heard about what they called “sex-change surgery” back then (and now call “gender-affirming care,” because euphemisms come for all of us in the end), I thought it sounded like a great idea. I told anyone who would listen that I wished I was a girl and I spent a decent amount of time in my sister’s room when she wasn’t around, trying on her clothes and jewelry and making kissy faces at myself in the mirror.

(I just remembered that she reads this blog sometimes and she may not have known that.)

(Oh well.)

These feelings mostly faded away as I reached puberty and matured—which, to my understanding, is a fairly typical experience for gender dysphoric kids (the research I’ve seen suggests that a large majority of cases of youth gender dysphoria go away naturally—which, put a pin in that, we’ll circle back to it in a sec). I don’t know if I ever started “identifying” as a man, because I have no idea what “identifying” as something even means; mostly, I just came around to the realization that it’s not the freaking Victorian Age and my gender is probably the least interesting or relevant thing about me—useful, maybe, when I need to move heavy things, help conceive a child, or write my name in the snow, but otherwise not worth giving a lot of brain space to.

When I was in my late twenties, though, I did experiment some with hormones, albeit inadvertently: I developed a thyroid disorder that caused my testosterone to plummet and my estrogen to skyrocket. The result was total bodily havoc: crazy mood swings, hyperactivity, dangerous weight loss, my eyeballs blowing up like balloons (no, really), and—had the disorder gone untreated—a slow, painful death. And obviously that experience was far from identical to hormone therapy under a doctor’s supervision, but it did drive something home for me: that despite my intrigue when I first heard about sex reassignment, there is no male/female switch on my body. There’s just the way it’s supposed to work, and then there’s my body being at war with itself (and, y’know, losing¹).

But why am I telling you all this? I guess to help you understand why a chill runs down my spine whenever I see a bumper sticker that says “Protect trans kids!”: because a lot of those bumper-sticker-havers would have considered me a trans kid, and I know from the inside what their protection is like.

(Article continues after the break…)

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ii. bro do u even #science

But here’s why I’m bringing this all up now: the UK’s National Health Service just dropped a 400-page systematic review on youth gender medicine. It concludes, after reviewing all the studies out there, that there’s just no good evidence that the way we’ve been treating gender dysphoric kids—social transition, puberty blockers, hormones, surgeries—is of any benefit to them. There’s no reason to believe that any of it improves mental health, or gender dysphoria, or—crucially—even suicidality. This should surprise very few of us, since “We’ll turn you into a girl by shooting you full of the girl chemicals” is magical thinking on the order of “Circle, circle, dot, dot, now you’ve got your cootie shot,” but of course there are plenty of people out there tying themselves in knots to undermine the study’s results in order to (you guessed it) “Protect trans kids!”

But here’s the thing: if these treatments are of no benefit, then keeping them around does nothing to protect trans kids.

I’ll be honest and admit that what’s often termed “gender ideology”² has always struck me as weirdly incoherent (“We’re dismantling the cis-hetero-patriarchy by overturning oppressive gender norms!…but if you like pink, that means you’re a girl, bucko”), but I think all of us can agree on at least a couple of things—namely that gender dysphoric kids exist (I know this because I was one of them), and they’re absolutely deserving of empathy and kindness (because, y’know, everyone is³). And I’ll grant that some of them are probably in need of medical or psychological attention. But even if all that is true, it doesn’t follow that any particular course of treatment is necessary or beneficial.

I will (bravely) go on record as believing that (for instance) brain cancer patients (1) exist, and (2) deserve kindness, but if you’re looking to treat them with bloodletting and trepanation, you’d better have some very good evidence that those treatments will actually help them. That’s doubly true if your patients are minors who can’t possibly wrap their heads (so to speak) around exactly what they’re signing up for.

At the very least, you ought to be able to show that the proposed treatment is more likely to help them, and less likely to harm them, than doing nothing at all. That’s the real crux of the issue, since we have good reason to believe that puberty blockers and cross-sex hormones come with a lot of serious risks—everything from low bone density to sterility—whereas simply letting kids go through puberty seems to clear up gender dysphoria in a solid majority of cases (this, again, was my experience). Every treatment comes with risks, and if you can’t prove they’re outweighed by the potential benefits, you have no business prescribing the treatment; for some reason, all the Smart People understand this when the treatment in question is Ivermectin, but with youth gender stuff, the evidence (or lack of it) seemingly doesn’t matter.

But the evidence always matters, or at the very least, it probably should matter to the crowd with “Science is real!” signs on their lawns. I’m far from the first one to point this out, but “science” is a word with a pretty specific definition: it doesn’t mean “believing whatever Instagram activists tell you,” or “thinking dinosaurs and space are cool,”⁴ or even “squealing and fainting every time Neil deGrasse Tyson opens his mouth.” Science is a process of collecting data and subjecting it to strict scrutiny—and, as the NHS’s new report will tell you, no one has been doing that when it comes to youth gender medicine. (And if you don’t want to believe it from the NHS, here it is from the governments of Sweden, Finland, Norway, and [in case you, for whatever reason, prefer your youth gender medicine with a side of alligator wrasslin’] Florida.)

Shouldn’t we be at least a little concerned about that?

iii. but why am i bringing this up now?

I mean, cowardice, mostly.

The NHS’s report definitely gave me a nudge, but the truth is I’ve been wrestling with various versions of this essay for almost a decade now.⁵ While it’s not lost on me that stuff like this tends to do well on Substack, it’s also not lost on me that publishing stuff like this can be career-ending or worse. It’s also-also not lost on me that once you publish something about this particular topic, the audience that only wants to read about said topic takes over your comment section, and possibly your life, pretty quickly. And it’s also-also-also not lost on me that I might be inviting a flood of harassment and/or ending my chances of ever putting out a novel with a major publisher by putting this out there.

So, I guess you can parse that however you want. I’m bravely standing up on an issue, right around the time that it’s becoming safer to do so. This really isn’t the sort of thing I like to write about—writing about culture war bullshit reliably brings in readers, but it also feels like rolling in the mud with the pigs; I’d much rather be writing about pop culture or philosophy or why Twitter sucks so much. This is an issue that hits pretty close to home for me, though, and not just because of my childhood: these days, I have a nine-year-old autistic daughter who eschews dresses, keeps her hair short, and likes to hunt bugs, and I can’t imagine anyone telling her anything more insulting or damning than that she’s actually a boy—we all have enough reasons to hate our own bodies, without piling one more on.

And of course, we are our bodies, so there can be no happy ending to that standoff.

Anyone looking to prove that I’m a Rightwing Extremist™️ will likely be disappointed—if you feel like digging through my now-seldom-used social media accounts, you should be able to find ample evidence of my status as a BernieBro and my many years of Trump Derangement Syndrome.⁶ But, of course, I’m also not looking for the approval of people who would give it based on my political views, as such people tend to be very, very boring. Political litmus tests are lousy things on which to build friendships, or professional relationships, or societies.

All I’m looking to be is a voice reminding you that the Right Side of History™️ rarely makes itself manifest until history has long since been written—and that’s especially true when it’s a question about Science™️. A century ago, Science™️ “knew” that we needed to sterilize the intellectually and phsyically disabled; half a century ago, Science™️ “knew” that an icepick to the brain was the perfect all-purpose cure for mental illness; a quarter-century ago, Science™️ “knew” that millions of us were hosting multiple personalities in our heads, thanks to repressed memories of ritual abuse. These collective brain fevers eventually worked themselves out, but not without ruining a whole lot of lives and enriching a whole lot of lawyers. Youth gender medicine appears to be headed in a similar direction.

Anyway. I’ll be back in a week or two with something about a terrible horror movie or something normal like that. See you guys then. 🕹🌙🧸

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⬅️ In case you missed it: What’s the deal with Melchizedek?

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1. WOOOO I’M KICKING THIS GUY’S BUTT

2. I know a lot of people bristle at the term “gender ideology,” insisting that it, along with “woke,” is just a rightwing slur. But come on…(1) you have a set of ideas (i.e., an ideology), and (2) those ideas are about gender. “Gender ideology” is literally the most neutral term I can imagine for it. If you want me to call your school of thought something else, I will; just tell me what you want me to call it! But I have to call it something.

3. Unfortunately for the Kindness Police, “everyone” is a very large set that includes everyone from Rachel Dolezal to Donald Trump

4. I want to be absolutely clear about this, though: dinosaurs and space are super freaking cool.

5. Yes, that means it predates Substack.

6. To be clear, the Orange Man was well worth being deranged over. But so is youth gender medicine! Isn’t it great how everyone can be full of terrible ideas?