Which would you prefer? To be always noticeable as a trans woman, to be subject at any time to others’ prejudices, but to be fertile and able to father a child, or to be indistinguishable from any other woman, albeit one without a womb, but sterile? Can you decide, aged even 18, whether you will want children at some time?
It is possible to defer puberty until a child makes the decision whether to transition permanently, and then give cross-sex hormones. Many adult trans women would like to have been so treated. Passing matters. We flourish better if we are not constantly worried about other’s real or imagined prejudices. You can adopt, or foster. Clever things might be done with stem cells: ordinary skin cells may be converted into stem cells.
Any use of cross-sex hormones, even with a natural puberty, might affect fertility. Never using cross-sex hormones might make passing more difficult.
Doctors do not make people “well”. They have a number of treatments which might improve a person’s condition. They do plastic surgery where there is no medical need. I do not believe in a discrete group which is transsexual, which will clearly benefit from transition. Our circumstances and our resilience affect whether we can make a go of life, and whether that should be as male or female. I can imagine a regret of either course. A doctor might want their patient to fight for puberty-blockers, so that the doctor could not be blamed later for loss of fertility.
An adult knows it will not grow back.
The Royal College of Psychiatrists position paper acknowledges the need for better evidence on the outcomes of pre-pubertal children who present as transgender or gender-diverse, whether or not they enter treatment. Until that evidence is available, the College believes that a watch and wait policy, which does not place any pressure on children to live or behave in accordance with their sex assigned at birth or to move rapidly to gender transition, may be an appropriate course of action when young people first present.
That says nothing. “First present”- what about after? It gives discretion to the doctor involved, to suppress puberty if they decide it is appropriate. Doctors might want a wide range of options, but not to be blamed for any of them. I do not blame doctors for the treatment which I wanted, and want them generally free of blame- it means that others can choose what I chose. If we blamed the doctors for wrongful treatment, we make their gatekeeping more onerous on those who follow us. We have to make these decisions for ourselves.
The mood of the paper is limiting treatment. “Better evidence on outcomes”- we fear this means, no puberty blockers. Parents and children can be particularly keen on puberty blockers.
I like the idea of the child following their own desires. Let them find what way suits them. I would like children to be able to experience both presentations side by side- to be able to go to school as boy or girl as they wished on the day. The RCP will not say that: The Department of Health and Social Care and the Department for Education should ensure all schools provide appropriate staff training and have clear policies that support transgender children. These include tackling bullying, effective safeguarding, parental concerns, and practical considerations (such as appropriate language, use of toilets and changing rooms, and uniforms). They make no suggestion what that policy might be.
We want the best for children- and not in some ideal world but the world they must navigate, now and throughout life. That I regret a decision does not mean that I would be happier had I decided the other way. Life will be hard on gender diverse people whatever choices we make. Life is difficult for everybody.