The Nuffield Council on Bioethics has launched an open consultation on treating gender dysphoric children and adolescents, to which anti-trans campaigners may easily respond. The working group does not include a single trans person. Dr Ruth Pierce has written a detailed critique of the project and its inadequacies. I had a look at the questions.
Nuffield produces reports on ethical issues in bioscience and health. It is funded by the Nuffield Foundation, the Medical Research Council and the Wellcome Trust. This page has links to its work on gender identity. This is its call for evidence.
They start by asking what gender dysphoria is, explaining that some people think it is a medical condition- genetic, hormonal, neurodevelopmental or psychiatric; some think it a social construct, and some a “normal variant of gender expression”. They don’t want a single agreed view, but want to understand how different views affect the approach to care and treatment.
Trans is what some people are, just as gay is. Attempts to suppress our personality fail. Attempts to prevent us from expressing ourselves through transition may succeed, though at the cost of great psychological distress.
Gender dysphoria is the distress at having to conform to the wrong gender, or at living with transphobia including internalised transphobia.
Those anti-trans campaigners who imagine they are left-wing feminists conceive of transgender as a threat to AFAB children: to those who want to transition, whom they call girls, threatened by infertility and physical changes preventing them from living their lives as “adult human females”; and to cis girls generally, from trans girls, whom they characterise as a threat to privacy or even a sexual threat. They cannot believe that transition could ever be right for someone.
However, trans people exist. Transition benefits us. Medical treatment with hormones and surgery at the very least helps us pass better, so to function better in a transphobic society, and at best cures the gender dysphoria arising from our bodies being wrong. Before transition I hated my body. Now I love it.
Anyone asserting that transition is always or mostly wrong is therefore denying reality, and their views should be discounted. However as Ruth Pierce shows the Nuffield press release quotes the approbation of extreme anti-trans campaigners.
Nuffield then asks what social factors are most relevant to the discussion on gender identity, and names a number of possibilities. On “intense sexualisation and objectification of women” I would add rape culture and pervasive sexual violence, but not primarily as having an effect on the trans boys but on the anti-trans campaigners. Many who once were feminist have been traumatised by that sexual violence, and they imagine that trans boys are fleeing it rather than expressing their true selves. It blinds them to the phenomenon of the trans boy who benefits from transition.
Nuffield names “increased visibility of trans individuals in public life”. Well, yes. Rather than trying to conform to the assigned gender, we realise transition might be possible. I felt I could not transition, because the trans women I knew seemed to be having awful lives. When I met some who seemed to prosper, it seemed possible that I could make a go of life as a trans woman, and so I decided to transition.
It does not mention the public transphobic campaigns of the Republican party in the US and the Conservatives and their allies here. That terrifies trans children, and makes them attempt to conform to their assigned gender. It causes mental anguish and even illness. We live in an atmosphere of extreme transphobia. That Nuffield names homophobic bullying but does not explicitly name transphobic bullying shows that they are trying to find a mid point between trans people and the anti-trans campaigners, rather than finding what is right for the children.
Nuffield then asks whether the evidence base justifies the use of puberty blockers and gender affirming hormones (which they call “cross-sex hormones”). I don’t know. There are great difficulties with producing evidence that these treatments are beneficial- the privacy of the trans people involved, the rarity of treatment, and the reasons why treatment is given. Trans children want PB and GAH because they want the right sex characteristics and not the wrong ones. Gender clinics justify treatment as a way of alleviating distress at the time of treatment, not anticipated problems and benefits in the future. That fits Nuffield’s next question- what should be the purpose of PBs?
How should trans children be treated? Before asking this, by way of context, they refer to “desisters”. I would draw attention to people who detransition under the extreme transphobia of society, and later transition again.
Nuffield asks, “Should children be encouraged or supported to transition socially?” Of course. It is the only way to find whether they will prefer life transitioned. But look what Nuffield has to say. Social transition “makes it difficult for young people to change their minds, and in fact increases the likelihood of later medical transition”.
Social transition of cis children is torture. It does not work. This way of presenting the issue makes transition look like a bad thing. The point is, for trans people, social transition makes our lives better. We do it under the pressure of worse transphobia than in Britain now. Nuffield is echoing transphobic talking points.
Nuffield then asks about a range of harms, even those which might be seen as harming those who do not desist, such as, loss of fertility. Stem cells can be made to develop into gametes. That is the way to address loss of fertility. They posit “the negative consequences of disrupting physiological puberty, given the role it might play in the formation and development of a consistent gender identity”. That is mere speculation, simply a more formal way of saying “Don’t indulge them. They’ll grow out of it.” BUT WE DON’T.
This is what Ruth Pierce means about the distress of facing these endless questionnaires, surveys and consultations. I want to cry. Why can Nuffield not see?
Then they ask about consent. They go into detail on the doubts expressed by the judges in the Bell case. They ask, “Do you think that children and adolescents have the capacity to consent to PBs and CSH?” No, scream the anti-trans campaigners. Trans people don’t say there are no risks, just beg the cis gatekeepers to consider the risks of not treating.
Again, the questions make the anti-trans case. “Is there anything distinctive about PB and CSH that they warrant a different standard of consent?” No, not really. All treatment has risks. Should a fifteen year old girl have an abortion? What if she regrets it, and is incapable thereafter of becoming pregnant? There is nothing distinctive, because this is treatment which can have great benefit. Many claims of risk are fearmongering and evidence-free speculation. But transphobes are so wise, and disinterested, in their calls for “transparent public debate”.
My sarcasm is a defence mechanism.
Nuffield asks if there’s anything else you want to say. Getting the distinctions and similarities clear in your mind, clarifying why phobes’ objections are irrelevant, is a particular skill. Not all trans people have that skill. Facing demands for explanation, we might just give up. Nuffield will produce a report over many pages, with many considerations weighed and taken into account, but for us it’s quite simple.
Transition saved my life. It may save others.
I am not going to answer this consultation. I dare to hope someone will express the potential benefits of PB and GAH in such a way that it will be clear to any disinterested person that they should be given, and that only considering the alleviation of current distress to justify treatment is unethical.