If you’ve attempted discussions with fellow Democrats about medical interventions for gender distress, you’ve probably run into well-worn slogans and unfounded claims — the result of successful misinformation campaigns, a polarized political climate, and heightened emotions around “gender.” Understanding the issues and planting seeds of doubt will help engage your conversation partner’s critical thinking skills and create opportunities for change.

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The examples below outline challenging conversational situations and provide ideas and resources for re-framing the issues and educating fellow Democrats.
 

If you question “gender-affirming care,” it’s because you’re transphobic.

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Questioning the safety and efficacy of treatment practices for people experiencing gender distress was, until recently, standard medical practice. It is also vital if we are to be ethical doctors, therapists, teachers, and parents. The medical interventions known as “gender-affirming care” (GAC) — puberty blockers, opposite-sex hormones, and cosmetic surgeries — run a high risk of harming vulnerable patients, and create lifelong dependence on medication in previously healthy children and adults. The evidence that such interventions relieve distress is low quality and/or completely lacking as demonstrated by the WPATH Files and the Cass Review. All people deserve evidence-based medical care.

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Questions to ask:

• If you discovered that GAC lacked evidence and did not result in good outcomes, how would your thinking change?

• How can we ensure that all people receive evidence-based medical care? Should politics play a role in the quality of care certain people receive?

• How is the concern that GAC might be substandard a sign of being “transphobic”?

• What does it mean to be “transphobic”?

• Specifically, what are you hearing that you believe is “transphobic”?

• What are some possible reasons someone might be concerned that aren’t due to “transphobia”?

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People who object to “gender-affirming care” are all right-wing bigots.

 

Concerns about medical interventions that affect brain development, bone density, fertility, risk of stroke and cancer, and overall quality of life are not right or left issues. People across the political spectrum are concerned about the lack of evidence for these interventions, and understand that the promotion of the belief that we each have an innate “gender” (known as “gender identity”) that may be different from our sex is straight biological denialism, as well as harmful to women and dismissive of gay, lesbian, and gender non-conforming people.

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Questions to ask:

• What are some reasons I might object to GAC other than that I am bigoted? 

• What would you need to know in order to believe my objections are not based in bigotry?

• How could we talk about quality of care for those with gender distress without bringing in political positions?

• What evidence do you rely on to consider this a right-wing position? How do you tell who is a bigot and who is genuinely concerned about quality of care?

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If “gender-affirming care” is so harmful, why does every major medical association support it?

 

Doctors and medical associations in the U.S. have been following the lead of  the World Professional Association for Transgender Health (WPATH), an organization recently exposed for violating the core tenets of medical ethics, and practicing “citation laundering.” The U.S. is an outlier on this issue. Many countries in Europe have placed strict limitations on GAC due to a lack of evidence. Most recently, England and Wales have banned puberty blockers outside clinical trials and recommend extreme caution for other interventions for youth. The Cass Review has made clear there is little to no evidence for these medical practices. Our medical authorities are lagging behind.

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Questions to ask:

• What other times have doctors been wrong about medications or surgeries? 

• How confident are you that these medical associations are always right? How confident are you that countries who have banned or limited these interventions are wrong?

• How do you think profit motive might be influencing the stance of major medical organizations?

• How would you feel if you found out there was no evidence base for these interventions? What should be changed?
   

Some people have always been uncomfortable in their bodies. Shouldn’t we help them?

 

Most liberals have long been in favor of abandoning sex-based stereotypes and are comfortable with children experimenting with different activities or wearing clothing or hairstyles that are atypical for their sex. However, children go through developmental phases and can (and should) change their minds often. Evidence demonstrates that most gender-distressed children reconcile themselves to their sex by going through puberty, and the majority of these children grow up to be same-sex attracted. Being uncomfortable is part of the human condition and the healthiest path is to help everyone accept their sexed bodies.

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Questions to ask:

• What does it mean to be “born in the wrong body”? 

• What evidence do we have that hormonal or medical interventions resolve feelings of discomfort?   

• How might medicalizing adolescents with sex-atypical gender expression promote regressive sex stereotypes? 

• How is identity formed? Do children’s identities arrive as fully developed or are they always evolving — tested, constructed, rejected, and integrated over time?

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Shouldn’t we, as liberal Democrats, respect pronouns and preferred names, and embrace the gender spectrum?

 

The Cass Review unequivocally states that social transition should be treated with the same caution as prescribing pharmaceuticals — pronouns are generally the first step in social transition. As the party of science, we need to hold the line on reality, and not allow feelings to replace facts. Agreeing to call men women and vice versa is a slippery slope towards erosion of hard won rights and safeguarding for children and women. It is not respectful to manipulate language to negate biological truths. We celebrate gender non-conformity in all its forms, but sex is binary.

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Questions to ask: 

• What are some possible negative outcomes of allowing people to choose their pronouns and require others to use them?  

• How will the lost meaning behind “he/she” impact crime statistics, census data, health care data, etc.? What are the implications if institutions don’t record biological sex?

• How does using wrong-sex pronouns compromise sense perceptions, especially of children?

• Are there ways to support gender non-conformity without negating biological reality or compelling speech?

 

Isn’t trans just like being gay?

 

Gay and lesbian people ask to be accepted for who they are. They demand no rights beyond those every person enjoys. Trans activists insist that trans-identified people be accepted for who they are not.  Being gay has to do with sexuality — being attracted to the same sex. Those experiencing gender distress wish to be the opposite sex. These are very different.

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Questions to ask:

• What does it mean to be same-sex attracted if anyone can self-identify as male or female? 

• What does it mean if gay and lesbian kids, who often exhibit gender non-conformity, are told that means they are in the wrong body?  

• What are the consequences of teaching kids that there is something wrong with their bodies if they don’t conform to sex stereotypes? 

 

People regret getting tattoos sometimes, but we aren’t trying to outlaw tattoos. Adults should be free to make their own choices. 

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Tattoos, unlike puberty blockers, opposite-sex hormones, and surgical sex-trait modification, do not cause bone loss, interfere with brain development, increase risk for stroke, blood clots and heart attack; do not cause sterility, vaginal atrophy, or anorgasmia; nor do they involve removing perfectly healthy body parts. All people — adults and children — deserve evidence-based care.

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Questions to ask: 

• Is regret about the permanent loss of sexual function, reproductive capacity, and body parts like breasts and genitals comparable with tattoo regret? 

• What would your reaction be if you knew that the care given to trans-identifying people was not based on quality evidence? 

• What level of care do gender-distressed people deserve — is it what they say they want, or what the evidence show is safe and effective?  

• If exploratory therapy was shown to help gender-distressed people more than surgeries, would it change your mind about what such people need?

• What is the difference between elective cosmetic surgeries such as breast augmentation, and elective cosmetic surgeries for patients who say they are trans?