SO IT ALWAYS IS WITH GOOD INTENTIONS.

Might sex change operations for pre-adolescents be of dubious value?

The medical practice of treating children who are distressed about their gender started out with good intentions. But this case, at its core, represents the profound failures that have occurred in our institutions. Failures that began when activism took over science. Failures that can only be corrected by the courageous, and now the courts. It should never have reached this point, but here we are.

And if my child claims to be Thomas the Tank Engine, does medical science recommend we book him into the Brighton works for new flues?  Or if she claims to be Squirtle, do we give her a sphere to curl up in and sink it in the tub with her in it?  At least in those hypotheticals, common sense is ahead of The Science.  Those kids who think (for this week?) they're in the wrong body aren't as fortunate.

These failures began with the American Academy of Pediatrics and the Endocrine Society. These medical organizations quite suddenly embraced the idea that any child who expressed gender distress must immediately be affirmed and swiftly medicalized.

This then spiraled as risk-management departments and ethics boards at major hospitals grew fearful of raising questions about why there was an explosion of children and teens who wanted this treatment. Not only were these treatments moneymakers for hospitals—it quickly became career-threatening to raise any concerns about this new branch of medicine and the dangers of subjecting young people to lifetime treatments with unknown consequences.

That was once the practice with tonsillectomies, but the complications therefrom were not as severe.

At our gender clinic, patients often had glaring comorbidities like depression, anxiety, ADHD, and eating disorders, or were on the autism spectrum. Many were young people who, if left alone, would most likely grow up to be gay men and lesbians, like myself. Yet we sold our patients the idea that if they are at all different, or gender nonconforming, they must be trans.

I saw teenage girls, with no history of dysphoria, being approved after just one meeting with a therapist. My colleagues could see social contagion as a potential factor in other conditions like Tourette syndrome, tic disorders, and “multiple personalities.” But with gender dysphoria, even suggesting there was a social aspect at work risked accusations of “transphobia.”

I saw teenagers lose their sexual function before they could understand what this would mean for them. A 17-year-old female ended up in the emergency room thanks to a hormone prescription from the clinic. The testosterone she was taking had thinned her vaginal tissues, and her vaginal canal had ripped open after intercourse, requiring surgery.

I saw regret in my patients a few months after it was too late. An 18-year-old girl who had a double mastectomy, only to decide to accept her female identity, begged us, “I want my breasts back.”

Oops.  And where is today's Lionel Trilling to call attention to the irritable mental gestures of the transgressive?