Reading New York City mayor-elect Zohran Mamdani’s “LGBTQIA+” platform, I was reminded of Thomas Chatterton Williams’s recent essay on the perils of “moral certainty.” The rhetoric of moral absolutism, Williams argues, often functions as a “thought-terminating cliché” that obscures nuance and ends debate.
Williams’s observation fits neatly with Mamdani’s assertion, in a recent interview, that making medical transition available to New Yorkers of “all ages” is our “moral obligation.” Mamdani’s framing effectively ends debate on the ethics and effectiveness of pediatric medical transition before it even begins.
Finally, a reason to check your email.
Sign up for our free newsletter today.
Other elements of the mayor-elect’s LGBTQ platform are similarly divorced from the developmental realities of children and adolescents. These luxury beliefs seem more likely to undermine psychological development and parental rights than to improve the mental health of trans-identified children and teens. Mamdani’s LGBTQ platform would legally protect “affirming” medical care and make it more accessible by expanding telehealth and virtual options. Similarly, Mamdani seeks to use a new LGBTQ+ Affairs office to centralize “affirming” mental-health services and to reinforce the social affirmation of minors as the default approach in New York City schools—even without parental consent.
Mamdani’s plan to “oversee an expansion of LGBTQIA+ healthcare clinics in all five boroughs” also seems destined to lead to ideological rather than evidence-based treatment for dysphoria. The mayor-elect has promised to set aside $65 million in taxpayer funds to expand access to “affirming care.”
The vision of “affirming care” peddled by Mamdani is likely to harm New York City youth, who will invariably be pushed toward medical transition. As critics point out, the “affirming care” model often prioritizes patient “embodiment goals” when making treatment decisions, while paying lip service to psychological evaluation and assessment.
An irreconcilable tension exists between the “affirmative” model’s unwavering commitment to medically validating a child’s cross-sex identity and the ethical demand for screening and assessment to rule out a differential diagnosis. Indeed, some “affirming” clinicians argue that psychological screening is a form of “gatekeeping” that stigmatizes and harm patients. This turns medical ethics on its head.
Needless to say, Mamdani’s “affirming care” dictate—and its interaction with New York State and City law—is likely to discourage more developmentally informed physicians from working with dysphoric youth, while creating a workforce of physicians and mental-health workers that self-selects for “affirming” activists. Patients are unlikely to encounter psychotherapists trained to develop alternative case formulations to explain the nature of their distress, meaning these clinical encounters will funnel vulnerable youth down the “transgender conveyor belt.”
Similar issues afflict many of the initiatives of Mamdani’s planned Office of LGBTQIA+ Affairs, including its proposals to create a centralized hub for “affirming” mental health providers and to put LGBTQIA+ and gender “liaisons” in schools to enforce “nondiscrimination” law.
Mamdani’s platform aims to codify New York City guidance maintaining that city schools do not need to get parental consent before addressing students by their chosen name and pronouns. This despite the fact that systematic reviews have not found strong evidence for the benefits of social transition (the use of cross-sex names, pronouns, dress, and so on). Such a policy would also undermine parents’ right to direct their children’s upbringing and is likely to create an unhealthy adversarial dynamic between parents and children. Notably, the U.K.’s Cass Review also conceptualizes social transition as an active psychological intervention because of how it can potentially alter identity development. This makes it an inappropriate intervention to be left in the hands of New York City teachers and staff, who lack the proper clinical training.
Pro-affirming political figures like Mamdani continue to operate in a parallel reality, where medical-transition procedures for minors are regarded as “necessary lifesaving healthcare.” Meantime, countries like the U.K., Sweden, and Finland, following the best available evidence, have moved away from medical-transition procedures for minors. The Department of Health and Human Services’ peer-reviewed report on best practices for gender dysphoria conducted an umbrella review (systematic review of reviews) and also found only “low certainty” evidence for benefits.
While Mamdani earned praise for his pragmatic messaging on affordability, his messaging on LGBTQ issues is shot through with unwarranted moral urgency. In time, New Yorkers may come to realize that urgency is no substitute for thoughtful policy.
Photo by Michael M. Santiago/Getty Images