Transgender Treatments and Parental Rights

Photo by Okaloosa County School Board Public Meeting, CC BY 3.0 , via Wikimedia Commons

One of the most contentious issues of current times is that of transgenderism and what treatments should be available for transgender children. The issue has become sensationalized among on the right and a cultural touchstone on the left, but I have many questions about how common gender dysphoria is as well as the best way to address it.

There is some publicly available data on the number of transgender Americans. WiseVoter puts the national average at 0.5 percent and lists state data on a map. States with high shares of the transgender population seem to follow no discernible pattern. Both red and blue (and purple) states having both high and low levels. North Carolina has the highest percentage of transgender population at 0.87 percent (behind the District of Columbia at 0.92 percent) while Missouri has the lowest level at 0.2 percent.

The UCLA Williams Institute has another page of resources that breaks down the data more for youth. Nationally, the group puts the average at 1.4 percent of 13-17 year-olds, slightly higher than the national average for all ages. This means that there are an estimated 300,000 transgender teens nationally.

Some estimates are higher. A Pew study from 2022 found that 5.1 percent of young adults (under 30) identify as trans, including three percent who are nonbinary. Interestingly, there is a large age disparity with 3.1 percent of adults under 25 identifying as trans compared with only 0.5 percent for those aged 25 to 29.

There have been reports that indicate a sharp increase in the number of transgender Americans. In 2022, the New York Times reported that “the number of young people who identify as transgender has nearly doubled in recent years.”

Why this is true is uncertain, but I can think of a number of possibilities. The most obvious scenarios are either that the number of transgenders is rapidly increasing or that transgenders are more comfortable in coming out openly about their feelings to researchers. Other likelihoods could be that the statistics are flawed (the Times article notes that methodology has changed) or that the coolness factor of transgender in popular culture encourages more young people to claim that label. Another possibility is that transgender is being diagnosed more frequently because of changing definitions and social norms.

Even with the increase, transgender students and athletes are rare. For example, the UCLA data notes 8,500 transgender youth from 13 to 17 (1.18 percent) in my state of Georgia. Divided by 2,308 public schools, that works out to about 3.7 transgender students per school. Even fewer of those would be athletes.

The number of transgender athletes is harder to pin down, but a Newsweek report estimated the total number at less than 100 nationwide. The same report noted that of 15 transgender athletes competing in North Carolina high school sports, only two were trans girls (biological males). When Utah moved to ban transgender competition in high school sports, there were only four transgender athletes statewide and only one was competing in girls’ sports.

However uncommon transgenderism is, it is an issue. It doesn’t seem to be an emergency, however. We have time to study the issue and decide rationally on how to deal with it.

Part of the problem is that there are competing political ideologies. On the right, it has become a trope to demonize transgenders and their advocates as perverts and groomers. On the left, there’s a tendency to attack anyone who resists the notion that transgender youth should be granted whatever medications and surgeries that they want.

I know I say this a lot, but I think they are both wrong.

The rise of self-identified transgenders is curious and to some extent troubling, but it’s not a crisis. It certainly isn’t something that needs to be front-and-center on national newscasts and websites every night. I do have some sympathy for those who charge that the right-wing media is using the issue to rally their base and cash in on the anguish of families. Transgenderism can be a personal or family crisis, but it is not a national one.

On the other hand, I also agree that people who aren’t old enough to vote or drive aren’t old enough to be making decisions about surgeries that could impact their life and health decades down the road. It’s well established that rational thinking and impulse control are not strong suits for teens and adolescents.

On yet another hand (that’s three if you’re counting), there is also some truth to the claim that parents have the right to raise their kids as they see fit. People on the right are quick to claim parental rights are inviolable when it comes to vaccines, critical race theory, and the like but don’t want to acknowledge that if parents have rights in these areas, they also have to extend rights to people who hold different opinions on sexuality (if they want to logically consistent anyway, if they don’t mind being hypocrites they can claim rights and deny them to others).

I frequently like to point out that rights apply to our enemies as well. If we are going to be a free nation, then we are going to have disagreements about what sort of behavior is acceptable and sometimes you just have to let it go. If freedom only applies to people who make the choices that we want them to make, that’s not really freedom. True freedom includes the liberty to make bad, stupid, and sometimes even harmful decisions.

But rights are not absolute. How far should parental rights be extended in this area?

I think it depends on exactly what sort of behavior is being discussed. If a parent wants to let their child dress as the opposite sex or pick different pronouns, then I’d grant them a lot of leeway in that direction. Along those same lines, going to drag shows where there is no obscene or lewd behavior is going to fall under parental rights and freedom of expression.

Parents have the right to seek treatment for transgenderism for their children. Many of the arguments against transgender therapies could be (and have been) applied to gay conversion therapies by folks on the opposite side of this argument. Personally, I’m in favor of allowing both sorts of therapy under the First Amendment’s guarantee of free speech, which as it turns out, also applies to doctors and therapists.

I am less swayed by the parental rights argument when it comes to treatments that are more invasive and have the potential to do lasting damage. For example, I’m fine with talk therapy, but I’m more hesitant when it comes to prescribing hormone blockers and other drugs (none of which are FDA-approved for treatment of gender conditions), which often come with the possibility of serious side effects. I’m more leery still of allowing sex-reassignment surgery. I’ll note here that governments have a long history of regulating drugs and surgical practices, especially for minors.

It’s also worth noting that it isn’t just Republicans who are skeptical or cautious about gender dysphoria care. Forbesreports that European nations are becoming more restrictive of the treatments citing a low certainty of benefits and a “risk-benefit ratio of youth gender transition ranges from unknown to unfavorable.”

So what is the appropriate treatment for transgender youth? It’s possible that the best answer is to give it time.

As one online source puts it, “You may also find out that the feelings you had at a younger age disappear over time and you feel at ease with your biological sex.”

That advice is not from a pastor or Republican congressman. It’s from Britain’s National Health Service.

It is possible that intervening with medical treatments can short-circuit the body and mind’s own corrective actions that allow people to become confident and content with their own gender. Maybe by trying to help affirm the mental state of transgenderism, we are really doing long-term harm to both the mind and body.

One way to get an answer is to let the process play out. Forbes pointed out that 12 states have banned or heavily restricted treatment for gender dysphoria while five states have acted to protect access. This is an example of the laboratories of democracy in action, in this case acting as actual medical laboratories. We should be able to track data and determine which approach achieves better results.

The downside is that people are going to be hurt by the different laws, but which policy would be the one to hurt them? Everyone has an opinion, but science seems to lack a consensus.

As a live-and-let-live kind of guy, I think that many of the transgender issues can be settled by the principle of “if it doesn’t hurt someone else then it falls under freedom of expression.” Put another way, if someone does something but it doesn’t affect you, then it’s none of your business. To a great extent, that applies to how other parents raise their children.

This is an issue that has good people (and bad people) on both sides. Facing someone with a different opinion doesn’t necessarily mean that you are looking at a bad guy. It may just mean that you have a different understanding of the facts or a different emphasis on the best policy.

And in general, trans people should not be attacked for what may very well be a mental health issue. At the very least, they should be treated with the same respect and dignity that we should offer to all of our fellow humans. That’s basic human decency.