Sean P. Madden
As the proud father of a brave, kind, and caring 24-year-old transgender daughter, I am writing to offer a little insight into our family’s experience with gender affirming care and to hopefully correct some of the most egregious misinformation about it.
Over the past year, a flurry of anti-transgender bills have been introduced in the U.S., with bills targeting transgender people introduced in nearly every state. These bills and their proponents are backed by well-funded anti-LGBTQ+ organizations, such as Alliance Defending Freedom, which has received more than $96 million in donations and grants in fiscal year 2022.
Most damningly, the network focuses on the bans on gender-affirming care for juveniles that have been passed into law in 25 states. We know from our own experience how extreme and cruel these laws are.
When our daughter came out as transgender just before her 16th birthday, we really listened to her, trying to understand what she was going through and how to best support her. And, like many parents of transgender children at first, we wondered if this was a phase she would grow out of. Looking back, we didn’t really understand what being transgender meant for our daughter at the time, but we clearly understood that she was struggling.
One of the most common misconceptions about being transgender is that it reflects a choice. This goes hand in hand with the false narrative of “social contagion,” whereby children are said to be influenced to identify as transgender through peer pressure, especially through social media.
But after consulting with transgender care experts, I came to understand the ruling that the federal court made at the time after hearing the evidence: “Being transgender is not a ‘preference’; being transgender has a medically recognized biological basis and is an innate, irreversible condition.”
When I asked if my daughter might be going through a phase right now, her medical and mental health care teams told me that a transgender person is someone who “consistently, persistently, and persistently” identifies with a gender that is different from the sex they were assigned at birth, as opposed to a cisgender (i.e., non-transgender) person who is simply experimenting with gender expression that doesn’t conform to stereotypical notions of gender-appropriate appearance.
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In our family’s transition journey, we came to another important realization: doing nothing is not a neutral option, and for youth experiencing gender dysphoria, not intervening increases the risk of negative mental and physical health outcomes.
Gender dysphoria is a medically recognized condition that affects many transgender people and is characterized by debilitating distress and anxiety resulting from a mismatch between the sex assigned at birth and one’s gender identity. The onset of puberty and the associated development of secondary sex characteristics can cause or exacerbate gender dysphoria.
Myths about gender-affirming care are designed to scare parents
This was exactly the situation with our daughter, and in retrospect we fail her. Our desire to care for her carefully and diligently lacked the necessary sense of urgency to reflect the distress caused by her intense discomfort.
Critics of gender-affirming treatment for adolescents claim, without evidence, that kids are being rushed into such treatment, when in fact the opposite is true: A recent study found that the average wait time between when a transgender youth contacts a clinic and when they receive puberty-suppressing drugs or cross-sex hormones is 10 months.
This long wait reflects both the care and deliberation that families put into such decisions and the shortage of qualified medical professionals who can provide such care.
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For youth approaching the onset of puberty, puberty blockers may be appropriate to delay the development of secondary sex characteristics that are inconsistent with gender identity, and this is a fully reversible intervention.
Cross-sex hormone treatment may then be able to further treat gender dysphoria by bringing the body more in line with an individual’s gender identity.
“Our daughter has experienced significant relief from her depression and mood disorders since taking puberty suppressants and then starting hormone therapy. She has told us, and repeated publicly, that without this medically necessary care, she may not have survived her teenage years. Those who deny teenagers this medically necessary care are simply not offering any medically approved alternative therapy at all.”
The anti-LGBTQ+ groups that push for bans on gender-affirming medical care are the same groups that push for book bans in the name of “parental rights.” If parents have the right to direct what their children read, surely they should also have the right to consult with their children’s doctors to direct their adolescent medical care.
Impeding safe medical care is not a conservative value
I’ve been a registered Republican for decades, and I know that it’s not conservative for the state to come between children, their parents, and the doctors who know best how to care for them.
Politicians should not interfere with family medical decisions, especially when those decisions are in line with medical consensus.
Unlike the political world, where unscrupulous ideologues can recklessly promote junk science, courts rule on evidence presented under strict rules. Nearly every U.S. court that has considered the evidence in challenges to bans on sex-affirming treatments has concluded that such treatments are medically necessary, safe and effective, and supported by every major medical association in the country.
Last year, a Montana court, not a bastion of liberalism, blocked the state from enforcing its recently enacted ban on gender-affirming care, stating:
“The Court is forced to conclude that the Act’s purpose is disingenuous; it is likely to prohibit a result the Montana Legislature finds undesirable, under the guise of protecting minors. The legislative record is replete with hostility toward transgender people, misinterpretations of prohibited medical treatments, and statements by individual legislators that suggest personal, moral, or religious disapproval of sex transition.”
This explanation could apply to any of the other 25 state laws that ban gender-affirming care.
Politicians should stop trying to impose uniform regulations across states and interfere with the private medical decisions of families with transgender children and their doctors.
Attorney Sean P. Madden is the director of GRACE (Gender Research Advisory Council & Education), a nonpartisan communications and public affairs nonprofit that provides evidence-based education about transgender people and the medical care they receive. He is a retired lawyer, investor, and transgender rights advocate and defender. He and his wife live in Charlotte, North Carolina.
