This essay concerns the argument, all the rage over on X in the wake of House Republicans (joined by three Democrats) safeguarding minors, that children should not be forced to go through puberty. I also address the retort among transactivists that “cisgender” children are recipients of gender affirming care. For context, Georgia Representative Marjorie Taylor Greene successfully pushed through the House the Protect Children’s Innocence Act (HR 3492), which criminalizes the provision of so-called “gender-affirming care” (often modified with the compound adjective “life-saving”) to minors and imposes penalties on providers. Greene’s legislation, sure to fail in the Senate (where it requires considerable Democratic Party support to pass), has triggered a firestorm.
In the wake of the bill’s passage, Democrats took to the Internet to condemn the bill and rally the troops. One of the arguments among rank-and-file progressives uses the language of “consent” around puberty, as if children have a choice in a naturally unfolding developmental process. When developmentally appropriate, in the absence of abnormalities or intervention by endocrinologists, puberty is an inevitable process. Humans don’t consent to puberty any more than they consent to aging or dying. Humans don’t have a choice in such matters. They age and eventually die. That’s a normal part of life. To be sure, some are trying to cheat the effects of aging and even death. Indeed, this is the same transhumanist desire that animates people seeking to escape one gender to become another, like a hermit crab seeking a new shell.
We hear the absurdity in the argument from people who say they didn’t consent to being born. Readers who haven’t encountered this before may find this incredible, but people seriously make this argument. They’re right in a way: they didn’t consent to being born. Who does? Nobody consents to being miscarried, either. Or consider those who want limbs amputated because they think they have too many—as if one consents to having four limbs, or to having 20 digits. Imagine a society in which doctors remove the normal requisite of healthy limbs and digits because people didn’t consent to them. Don’t laugh; this has happened (see The Exploitative Act of Removing Healthy Body Parts). Imagine a society in which girls suffering from anorexia, because they think they’re too fat, are undergoing bariatric surgery or liposuction (see Disordering Bodies for Disordered Minds).
Those defending the artificially induced arrested development of children contend that puberty blockers are relatively harmless and reversible. Even if one doesn’t like affirming delusions, it’s no big deal, they say. But this isn’t true. Puberty blockers, when used in precocious puberty to delay early onset, make sense. In that case, the intervention is considered reversible, and the delayed developmental processes, including brain maturation, typically unfold once the blockers are stopped. However, when puberty blockers are used to suppress puberty that is starting at a developmentally normal time, the situation is different. Adolescence is a critical period for brain development, including cognitive and emotional maturation driven in part by sex hormones. Delaying or suppressing this developmental phase disrupts important windows of synaptic pruning, myelination, prefrontal cortex refinement, and emotional regulation.
Parents and their children who seek this intervention are often unaware of the potentially harmful effects of these drugs when used at a developmentally inappropriate time (still, that they’re effectively Peter Panning their kids ought to be obvious enough). In such cases, while physical puberty resumes in some fashion after stopping the blockers, the brain and cognitive/emotional development that normally occurs during the typical pubertal window may not fully catch up later; some aspects of normal development may be permanently altered because that sensitive window of opportunity has passed.
There is evidence that puberty blocking at a critical phase can have lasting effects on brain structure, behavior, cognition, and emotional processing. Any responsible parent must therefore ask about the long-term impacts on IQ, neurodevelopment, and emotional function. And they shouldn’t trust doctors to tell them the truth. Parents have a duty not only to study the particular matter, but also to learn how the medical industry exploits ignorance for profit (see Making Patients for the Medical-Industrial Complex; The Story the Industry Tells: Jack Turban’s Three Element Pitch; Thomas Szasz, Medical Freedom, and the Tyranny of Gender Ideology).
Being charitable (although I’m convinced of the harm puberty blockers pose to children), even if the argument were that we’re still collecting and collating the data on blocking puberty during critical developmental stages, no meta-analysis definitively shows that arresting puberty during this phase of development (Tanner stages 2-4) is safe. Being as cautious as possible with respect to the science on this matter, parents—or state actors who might override parental rights—put children at risk of brain/cognitive/emotional stunting by consenting to these therapies. Therefore, governments have a responsibility to the moral order (the same ethical demands that undergird the Nuremberg Code) to safeguard children against this by regulating what doctors are allowed to do (see Medical Atrocities Then and Now: The Dark Continuity of Gender Affirming Care).
For progressives and trans activists who say such decisions should be up to children, their parents, and their doctors, while the child and parent may claim a right to them, doctors have no right to pursue courses of action that may harm patients without objective evidence that the claimed benefit or need justifies the intervention. Just because somebody fears puberty, or for some other reason wants to avoid it, is not a reason to block it. Interventions require a legitimate medical justification, and that cannot be had because a professional association, such as the World Professional Association for Transgender Health (WPATH), has constructed “standards of care” that assert a justification. After all, the Church of Scientology established the Citizens Commission on Human Rights (CCHR) to legitimize L. Ron Hubbard’s doctrine of dianetics. Does that make the practice of auditing a legitimate medical practice? (See my satirical piece Dianetics in Our Schools.)
For those unfamiliar with WPATH, the transnational organization traces its roots to the work of German-American endocrinologist and sexologist Harry Benjamin. Benjamin’s 1966 book, The Transsexual Phenomenon, distinguished transsexualism from homosexuality and transvestism, argued for “compassionate medical interventions,” i.e., hormones and disfiguring surgery, and introduced a scale (later known as the Benjamin Scale) to classify degrees of gender dysphoria. (For a deeper dive in the perversion of science in this area, see my essays The Gender Hoax and the Betrayal of Children by the Adults in Their Lives; Fear and Loathing in the Village of Chamounix: Monstrosity and the Deceits of Trans Joy; Simulated Sexual Identities: Trans as Bad Copy.)
Aware of rhetoric on social media that cites the practice of gender affirming care for so-called “cisgender” persons (a neologism assigned to those who suffer no delusions about their gender), I want to spend the balance of this essay on stressing the point that gender affirming care that actually affirms gender, which is determined by gametes, chromosomes, and reproductive anatomy, presents a different case. The retort that “gender affirming care is used all the time on cis children” is indeed true, but with a big difference: in such cases, it is appropriate medical care. I will use the example of a boy born with a micropenis to illustrate. (I have used the example before; see Gender Denying Care: A Medical and Moral Crisis.)
Suppose the parents of a boy born with a micropenis, knowing they have a developmental window in which a doctor could provide hormones so that their son’s penis could grow to a normal size, but don’t do that because it doesn’t, in their view, jeopardize the life or health of that person. If that had been my situation, and my parents had made that judgment, to not do anything about it, and I got to be an adult male who couldn’t fix the problem because the developmental window passed, I would be bitterly angry at my parents for not intervening at the optimal moment, which might have allowed me to have a normal sized penis. My parents would have, in fact, harmed me by denying me gender affirming care of the real sort.
(A user on X objected to this example last week because he denied that parents or doctors could know whether a newborn has a micropenis. In fact, a micropenis is observable at birth. A micropenis is defined as a penis that is ≥2.5 standard deviations below the mean for age and gestational age, with otherwise normal male anatomy (scrotum, urethral opening, and typically palpable testes). Clinicians determine this by measuring the stretched penile length (SPL). A micropenis is a treatable abnormality—as long as the intervention is performed at the right developmental stage. The thought of parents in the grip of ideology, knowing this but not doing anything to help their son, should disturb anybody who cares about the well-being of children. The X poster never returned to drop the other shoe.)
Now, suppose a boy with a normal penis is born to parents who want to halt his puberty because he or the parents want to avoid the development of secondary sex characteristics. Who knows, perhaps they seek to Peter Pan the boy. Keep him in Never Never Land. At any rate, this is an instance of gender-denying care, or, as Health and Human Services Secretary Robert F. Kennedy Jr. referred to it in public remarks, “sex-rejecting procedures.” What parents would do such a thing to their child? The same parents who would Peter Pan their kid because the kid wanted it, justifying their actions as “affirming” their kid in “his identity.” Whatever the motive, the parents are supposed to safeguard the child, not harm the child because they or the child wants to stop puberty. Neither parents nor children have the right to this, just as they don’t have a right to remove their child’s limbs or digits (except in the case of extra appendages).
The House absolutely did the right thing in passing HR 3492—and the Senate should follow their lead and send the bill to President Trump’s desk. The Supreme Court would almost certainly uphold the law (see United States v. Skrmetti—The Supreme Court Strikes a Blow to the Madness of Gender Ideology). I have been waiting a long time for Congress to stop what are, by any objective ethical standard, medical atrocities. Whether woke zealots, sufferers of Munchausen’s by proxy, or parents swept up in social contagion—and doctors, of course—must be held accountable for failing to safeguard children. No parent would affirm an anorexic child in her fat delusion (see An Ellipse is a plane figure with four straight sides and four right angles, one with unequal adjacent sides). No doctor working from a scientific or moral standpoint would remove the limbs of a normal child who didn’t want them. Why would any doctor stop puberty or lop off healthy breast tissue of a young woman or invert the penis of a boy who said he wanted a vagina? This is madness. Puberty blocking in the case of precocious puberty, or removal of breast tissue in a boy suffering from gynecomastia, is entirely appropriate because there is an objective medical need. There is no such need in the case of gender dysphoria.
Society needs to ensure that gender affirming care remains available for anomalous cases where the developmental process did not unfold in the normal way, but at the same time make illegal any “medical intervention” arresting a normal process or altering children’s bodies because children and doctors believe they’re something they are not, or because the parents have been pulled into orbit around Planet Madness. Don’t call that “gender affirming care.” Because it’s not. It’s the opposite of affirming gender. And it’s not “life-saving.” A rational person must not tolerate the practice of emotional blackmail—the weaponization of empathy—in health care (see The Problem of Empathy and the Pathology of “Be Kind”).
freedom and reason 