The omitted false negatives in the trans-youth debate
In July 2018, journalist Jesse Singal published a long Atlantic cover story, “When Children Say They’re Trans,” which dwelt at length on adolescents who pursued medical transition and later regretted it, and argued for caution about giving puberty blockers and hormones to teenagers. The piece drew heavy criticism from trans communities for understating the costs of delay. This is a letter Alyssa wrote to Singal a few months later.
If you polled an average sample of 14-year-old women, I expect many would express a desire to become mothers. Most would have, if they wanted to, the biological ability to get pregnant and give birth. Western society acknowledges this desire — it doesn’t try to talk people out of it — but it encourages these women to practice safer sex and to delay pregnancy. After all, creating and raising a baby is very hard, and most people will be much better equipped to handle it at 24 than at 14, so delaying makes sense. My naive guess is that a lot of people walked away from the article with similar feelings about transition — that people should be able to get it if they want, but that inexperienced teenagers would benefit from taking more time to delay, reflect, and prepare.
Unfortunately, although that would be great in theory, the underlying biological reality is not so cooperative. With childbirth — or marriage, or tattoos, or joining the army, or most big decisions — delaying is reversible, while taking action is not. If you don’t get pregnant this year, you can (if under 35 and in reasonable health) always do it next year. If you do get pregnant this year, that’s much harder to undo, and once you start raising a child you’re pretty much locked into that, so it makes sense to be cautious. With transitioning, however, the situation is the exact opposite. Lupron and other puberty blockers are mostly reversible (I agree there are valid concerns about bone health and so on, but mostly). Natal puberty, on the other hand, is not reversible. Once it happens, well, that’s pretty much it, you’re stuck.
Therefore, although the article gives much space to trans people’s concerns, it doesn’t highlight the most important problem. Saying that someone can’t get treatment at 15 isn’t really a decision about their life as a 15-year-old. It’s deciding that they’re going to go through natal puberty, and that they’re going to live with the results of that, forever and ever and ever, even when they’re 75 and in a retirement home. The sense of urgency the article mentions might sometimes be misplaced, but it often reflects the biological dictate that there’s a limited window for action, and it doesn’t wait on our human schedules. I think our feelings about teen pregnancy would be very different if women hit menopause at age 17, and anyone who did not get pregnant would never be able to have children ever again.
The article profiles, in very eloquent detail, both young transitioners and young people who de-transitioned, and describes what their lives are like. In scientific terms, it covers both the true positives (transitioners) and the false positives (those who transitioned and regretted it). But it never really describes, in more than a cursory way, the false negatives, the people who needed to transition but were barred from doing so. There’s an endless stream of stories from people who are age 30, 40, 50, who need to transition, but are already adults and have adult bodies and often a spouse and children. And at that point, there’s often not much that anyone can do, their life is just going to suck and there’s no way out. IMO, the big decision isn’t really between teenage happiness and the chance of adult regret, but between two different forms of adult regret, both of which are serious but one of which statistically happens with much greater frequency.