Both critics and supporters of so-called “gender-affirming care” appreciated the candor of transgender activist and author Andrea Long Chu’s recent cover story for New York magazine.

Chu’s piece, titled “Freedom of Sex: The Moral Case for Letting Trans Kids Change Their Bodies,” makes a principled case for letting children dictate their own hormonal and surgical treatments. Chu believes that “trans kids” shouldn’t have to get a mental-health assessment before initiating hormones, and that, “in principle, everyone should have access to sex-changing medical care, regardless of age, gender identity, social environment, or psychiatric history.” Remarkably, Chu does not deny that biological sex is binary and determined at conception but argues that humans have no ethical obligation to come to terms with reality, calling this purported duty “a fine definition of nihilism.”

While trans activists often pretend that only “right-wing reactionaries” and “trans-exclusionary radical feminists” (“TERFs”) oppose their claims, Chu refreshingly observes that this isn’t true. The most “insidious” pushback, Chu says, has come from “TARLs,” or “trans-agnostic reactionary liberals.” Indeed, polling has shown that Americans with liberal views largely reject such policies as schools keeping students’ gender “transition” secret from their parents and allowing trans-identified males to compete in female sports.

Chu’s essay went viral, prompting New York staff writer Jonathan Chait to pen a “Liberal Response.” Chait has a history of opposing trans activists’ censoriousness, particularly about medical transition for youth. Last December, for example, he responded to transgender advocacy groups’ fury that the New York Times had acknowledged the ongoing scientific debate over how best to treat gender-distressed minors, which they claimed had abetted state-level Republican efforts to ban pediatric transition. Chait called for “carefully following the evidence,” and observed that “the whole reason leftists try to associate reporters at the Times with Republican-backed laws is precisely that their targets do not agree with the conservative position on transgender care.”

Chait’s December piece correctly identified the tribalist logic informing elite discussions of gender medicine in the United States, and progressive journalists’ efforts to banish from the liberal tribe those who raise questions about this controversial area of medicine. His response to Chu’s essay, however, fails to extend to conservatives the charity he expects trans activists to extend to liberals like himself. If Chait is worried about tribalism obscuring the pursuit of truth, he might consider how his own writing may contribute to this problem.

Consider his characterization of the debate over “trans rights.” Chait claims that “[c]onservatives dismiss trans rights altogether, while liberals completely support trans rights as it pertains to employment, housing, public spaces, and other adult matters, disagreeing mainly in how it is applied to children (as well as, in limited cases, addressing the problems raised by trans female athletes competing in women’s sports).”

Whether this is true, of course, depends entirely on what Chait means by “trans rights.” “Rights talk,” to borrow Mary Ann Glendon’s term, obscures the hard trade-offs and real-world costs that unavoidably confront those entrusted to make policy choices. Chait should have spelled out what “trans rights” mean in practice, but he doesn’t. His failure is especially puzzling considering two claims he makes in his essay. Chait claims, first, that “Trans-rights activists and their allies have relentlessly presented their entire agenda as a take-it-or-leave-it block, attacking anybody who criticizes any piece of it as a transphobe.” Second, he argues that rights claims generally render empirical questions irrelevant. As Chait puts it, “if, say, you consider firearm ownership an absolute right, then no evidence about how many lives any particular gun-control reform is likely to save is going to make you support it.”

Whatever Chait means by “trans rights,” the notion that all liberals support permissive trans policies outside the pediatric medicine and athletic contexts is unfounded, according to the data. Partisan affiliations are not a perfect proxy for voter ideology, but it’s telling that a 2022 PRRI poll found 31 percent of Democrats and 55 percent of Independents favor laws that require people to use bathrooms that accord with their biological sex. A more recent YouGov poll found that 26 percent of surveyed Democrats backed such laws, with 22 percent unsure.

Assuming the “liberal” position on public accommodations is that people should be legally allowed to use bathrooms that accord with their subjective definition of being male or female (and many liberals would dispute that this is in fact a liberal position), and if the “conservative” position is that no such law should exist or even that laws should require bathroom access based on sex, then almost half of Democratic Party voters appear to hold views about bathroom access that could qualify as “conservative” under Chait’s scheme.

Liberal opinion similarly divides on the issue of trans-identifying inmates’ prison placements. According to the same YouGov poll, most Democratic voters either supported (35 percent) or weren’t sure about (33 percent) laws requiring prisons to house inmates according to their biological sex. In this case, support for “trans rights,” here defined as a legally protected right to be housed according to “gender identity,” appears to be a minority position within the Democratic Party.

Has Chait accurately characterized the conservative position in this debate? Despite his claim that “[c]onservatives dismiss trans rights altogether,” there’s no evidence that the standard “conservative” position on, say, employment is to allow adverse action against trans-identified people tout court. The YouGov poll found that 44 percent of Republican respondents said they support “banning employers from firing employees on the basis of their transgender identity.” Fifty-seven percent of Independents, which presumably includes some conservatives, answered the same way. Recalling the abstract nature of “rights talk,” what is framed as “employment non-discrimination” often comes down to policy questions about how employers should treat trans-identified employees or candidates in circumstances where sex presumably matters, for instance access to workplace bathrooms.

When asked whether there should be specific provisions for “transgender people in hate crime laws,” 42 percent of Republicans and 57 percent of Independents agreed that transgender status merits special protection, while 24 percent and 27 percent, respectively, said they weren’t sure.

In short, it is highly misleading to say that liberals support trans rights while conservatives do not. When the abstraction “trans rights” is broken down into concrete policy questions, as inevitably it must be, many liberals seem to disagree with policies favored by trans rights activists while many conservatives agree with them. Chait himself recognizes the uselessness of abstract rights talk when he turns his attention to Chu’s argument for “freedom of sex.”

Chait’s response to Chu’s arguments about pediatric medical “transitions” admirably makes the case that “empiricism” must be part of the liberal position on trans rights. However, his commitment to political “rights” seems to constrain his commitment to empiricism and evidence in crucial ways.

First, Chait notes that the supposed consensus that “gender-affirming care” is “settled science” is the result of “a power struggle between advocates of unmediated gender-affirming care and their more cautious colleagues,” but he doesn’t really explain what makes these colleagues “cautious” or whether there are divides within the “cautious” group. By this point he must know that there are three main positions in the debate: those, like Chu and parts of the gender medicine industry, who support unrestricted access to hormones and surgeries; those who support medical transition but call for rigorous mental health assessments; and those who believe that “gender-affirming” hormones and surgeries are inappropriate for minors regardless of circumstances. Those, like myself, who belong to the third group make evidence-based arguments. We regard members of the second group, many of whom are well intentioned, as cautious compared with the first group but overall misguided in their support for harmful practices.

While Chait mentions systematic evidence reviews from Europe and Canada, he fails to disclose that these reviews found no credible evidence of benefits for any pediatric cohort, including those treated under the “gold standard” and more “cautious” Dutch approach, which Chait notes involves “extensive evaluation and screening for mental health.” Left unstated is his apparent hope that after “extensive evaluation and screening,” some kids will benefit from early medicalization.

If liberals like Chait are truly committed to empirical medicine, they must at some point read and respond to the most important scholarly paper on pediatric gender medicine in recent years: “The Myth of ‘Reliable Research’ in Pediatric Gender Medicine: A critical evaluation of the Dutch studies—and research that has followed,” published last year. It’s hard to read this paper and come away with any impression other than that this entire medical field is based on fraud.

More fundamentally, Chait needs to grapple with a problem that runs deeper than the empirical questions discussed in clinical studies. Empirical debates about medical evidence generally presuppose a coherent conceptual framework of health and disease. We can debate, for example, whether a new drug for treating cancer is “safe and effective” because we agree that there is a condition to be treated (cancer), that it constitutes illness, and that doctors have an objective diagnosis to confirm its presence in humans.

Gender medicine, by contrast, lacks a coherent conceptual framework. The discipline is riddled with deep and abiding contradictions. Advocates argue that “gender incongruence” is not a pathology but a normal variation of human development, but they also insist that this phenomenon is a potentially life-threatening medical condition that requires “medically necessary” hormonal or surgical interventions. Advocates argue that “gender identity”—a term whose definition is either circular or reliant on stereotypes—is fixed, immutable, and infallibly knowable from early childhood, but they also say that “gender identity” is fluid and a “journey.”

Above all, thoughtful discussion of youth gender transition is not possible unless one is willing to interrogate the very notion of the “transgender child.” And this, I think, is still a bridge too far for liberals like Chait. What does it mean to say that a child “is transgender”? That she was “born in the wrong body”? That’s metaphysical talk, and absurd. It’s also dangerous to suggest such a thing to vulnerable teenagers who are going through the throes of puberty. Nor is there evidence for the transgender brain hypothesis—and even if there were, gender clinicians (even the “cautious”) ones are not calling for, and most would actively oppose, brain scans as part of the diagnostic process.

Liberal journalists who continue to use the term “trans kids,” as if it’s obvious what this means, without trying to define the term and defend it against rational, good faith criticism, are not truly interested in an empirical debate about youth gender medicine. They care about evidence and research, but only within limits.

A final note on Chait’s piece. He mentions the National Health Service of England’s recent decision to decommission puberty blockers as routine care for gender dysphoric youth. Chait should keep in mind that the Dutch first proposed using puberty blockers as part of the diagnostic process—halting puberty to create a window of time for the adolescent to sort out his feelings and decide whether to proceed with transition. We now know that these drugs do not provide neutral “time to think” (the title of a book about the Tavistock clinic) but more likely lock in a child’s incongruent gender feelings and make further “transition” all but a foregone conclusion. Chait seems to have read the Tavistock book and should at least be open to the possibility that the NHS’s decision is a step toward an eventual full national ban on medical transition for minors—similar to the restrictions enacted in two dozen Republican states that Chait presumably believes are extreme.

To his credit, Chait recognizes the potential for golden mean fallacies in the debate over youth gender medicine. He argues that we should not assume that “ideas located at the extreme at any given moment are always wrong.” I agree. But Chait should acknowledge the possibility that empirically minded, principled liberals like himself are still getting pediatric gender medicine wrong. He should be open to the possibility that one day in the not-too-distant future, he will find himself among the “conservatives.”

Photo by Larry Busacca/Getty Images for Time Inc


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