Exploration, not affirmation, is the best way to safeguard future choices for a young person and protect them from the serious harm of gender medicalisation
“Gender: Set of psychological traits, behavioral dispositions, and cultural expressions associated with the sexes. It includes a psychological dimension with an evolutionary basis and a variable sociocultural dimension.” Agreed!
During the five years 2014–2018 four years, 85 Aboriginal and Torres Strait Islander children aged 5–17 died by suicide in Australia.
By way of contrast, I can find no Australian national mortality data recording a single child suicide as being attributed to gender dysphoria, in fact it is difficult to find any such reference globally.
Yes Rachel, physicians marketing the transition nonsense have locked onto the most affective sales package, with the suicide lie. It's an ethical wasteland!
It is a very well-written article, and I agree with much of its analysis. But, with all due respect, I must point out a few differences.
The first has to do with a tension that runs through two paragraphs. In one, it is stated:
"While gender identity varies widely, this variability does not negate binary sexed embodiment or justify medical alteration of healthy bodies in the absence of pathology."
And in the next, it is dismissed as a metaphysical belief:
"appeals to autonomy in this context may be grounded in extra-factual beliefs—that is, metaphysical or philosophical claims about unobservable realities, such as the existence of a core gendered self or essence that exists independently of the body and must be aligned with social and medical affirmation."
If gender identity varies widely, as acknowledged in the first paragraph, then appealing to it is not an extra-factual belief about a nonexistent essence. Either gender identity is something real that varies, and therefore is not a metaphysical belief, or it is a metaphysical belief, and therefore the "variability" acknowledged is nothing more than an illusion. You cannot hold both at once.
The second difference is the one that appears, for example, in this sentence:
"It allows for multiple developmental trajectories, including resolution without transition, or later transition in adulthood, undertaken with much greater stability and decisional capacity."
That is, medicalization is rejected in young people but accepted as a legitimate trajectory in adulthood. This is contradictory with the article's own framework, which criticizes medicalization as a collapse of complexity and as something based on metaphysical beliefs. If these procedures are harmful and based on false premises, they are so both in young people and in adults.
The third is terminological. We must abandon the label of "medicalised" responses. They are procedures to alter phenotypic sexual characteristics; there is no medicine or medicalization there.
And the fourth is that it is time to stop saying that our knowledge is incomplete. Procedures to alter phenotypic sexual characteristics are iatrogenic. They can, in certain cases, provide fleeting and superficial relief, but they do not solve the problems they were supposedly meant to solve. The sentence:
"Ultimately, this debate is not about whether distressed young people deserve our love and support, but whether current practices adequately protect them when our knowledge is incomplete and consequences are lifelong."
Suggests that the problem is a lack of knowledge, when the problem is that we already know enough: these procedures cause harm, and there is no solid evidence that they benefit anyone.
Surely you can have a gendered soul which is manifested in different ways?
I take your point about terminology. I think “gender medicalisation” works as journalistic shorthand. Unlike medicine, medicalisation has a pejorative sense to it, meaning inappropriate use of medical technology & pharmaceuticals.
Bernard, on your first question, I believe yes, one can have a «gendered soul that manifests in different ways». In fact, that is a good way of describing it. The gender we possess is basically something given to us at birth, just like sex. Both sex and gender depend on genes, hormones, and the effects of those genes and hormones on the body (and obviously on the brain, which is part of the body). Gender consists of all those psychological characteristics that «surround» sex. They are like a kind of «helper» to sex.
Sex is the reproductive function; gender is those characteristics that revolve around it. Sexual orientation and all the other masculine or feminine traits emerged evolutionarily as facilitators of reproduction.
While sex is binary, psychological sexual characteristics present themselves along a continuum that has two modes or poles (masculine and feminine), so all of us have a bit of both poles in different combinations. This corresponds to the «gendered soul» in different ways or «flavors», and it also corresponds to being more or less gender conforming and to having a more or less conforming gender identity. They are, at the end of the day, different ways of referring to the gender each of us has.
On terminology, I appreciate your clarification and I understand that «gender medicalisation» works as a shorthand in journalism, and that «medicalisation» has a pejorative connotation referring to the inappropriate use of medical technology and pharmaceuticals. Precisely for that reason, I believe we must be careful: if both promoters and critics designate these procedures as «medicalisation», we are conveying the false idea that they are designed to fix something, to solve something, or to cure something. And at this point in history we already know that these procedures cause harm, because there is a wealth of studies and meta-analyses that have demonstrated it. That is why I propose calling them «procedures to alter phenotypic sexual characteristics», which describes exactly what they do, without presupposing a therapeutic benefit that has not been demonstrated.
It would be interesting to talk to a German about sex & gender because, as I understand it, German has one term which does not distinguish as we do in English.
I like the idea as a helper to sex. It’s often said that sex is real & immutable while gender is wholly socially constructed. Which doesn’t seem right to me. Rather, I think that gender usually operates within limits influenced by sex.
As for terminology, I understand your point. Some use the term “sex-rejecting procedures”. A paediatrician pointed out to me that minors have no endocrine disorder until they are given blockers & hormones. It is only at that point they become “patients” of iatrogenic medicine.
I wrote about gender and other terms here:
https://cabrerae.substack.com/p/clear-definitions-to-dismantle-trans
“Gender: Set of psychological traits, behavioral dispositions, and cultural expressions associated with the sexes. It includes a psychological dimension with an evolutionary basis and a variable sociocultural dimension.” Agreed!
A SHAMEFUL ETHICAL & RESOURCE MISMATCH
During the five years 2014–2018 four years, 85 Aboriginal and Torres Strait Islander children aged 5–17 died by suicide in Australia.
By way of contrast, I can find no Australian national mortality data recording a single child suicide as being attributed to gender dysphoria, in fact it is difficult to find any such reference globally.
https://nypost.com/2026/09/17/opinion/we-ran-the-data-on-transgender-teen-suicide-and-its-a-total-scam/?fbclid=IwZnRzaAUZP9RwZG9mBWZkaWQWUOn68VcrhSFZc97v4whqlXP1QEnJrWV4dG4DYWVtAjExAHNydGMGYXBwX2lkCjY2Mjg1NjgzNzkAAR5zu0m3KNz6fGzv5J7AcmgHamson3_XUge23A02GiqCcf0ZxzvIM0OK9BkYfQ_aem_vXaqOAWgf5-cl2-oy5a6oA
Yes Rachel, physicians marketing the transition nonsense have locked onto the most affective sales package, with the suicide lie. It's an ethical wasteland!
THE SEQUENCE:
1. A barely plausible theory is developed in otherwise empty space.
2. Physicians claim that an intervention will be lifesaving.
3. The intervention is adopted without sufficiently rigorous testing.
4. Critics are threatened with all manner of punishment.
5. Early positive impressions reinforce confidence.
6. Harms or lack of benefit are dismissed, overlooked or attributed to other causes.
7. Better evidence eventually forces a reassessment.
8. Muffled, sheepish eye-rolling.
9. RCH, AMA, RACP silent.
What number have we reached, Vincent?
10. I felt it was perhaps a little premature to get the lawyers involved.
It is a very well-written article, and I agree with much of its analysis. But, with all due respect, I must point out a few differences.
The first has to do with a tension that runs through two paragraphs. In one, it is stated:
"While gender identity varies widely, this variability does not negate binary sexed embodiment or justify medical alteration of healthy bodies in the absence of pathology."
And in the next, it is dismissed as a metaphysical belief:
"appeals to autonomy in this context may be grounded in extra-factual beliefs—that is, metaphysical or philosophical claims about unobservable realities, such as the existence of a core gendered self or essence that exists independently of the body and must be aligned with social and medical affirmation."
If gender identity varies widely, as acknowledged in the first paragraph, then appealing to it is not an extra-factual belief about a nonexistent essence. Either gender identity is something real that varies, and therefore is not a metaphysical belief, or it is a metaphysical belief, and therefore the "variability" acknowledged is nothing more than an illusion. You cannot hold both at once.
The second difference is the one that appears, for example, in this sentence:
"It allows for multiple developmental trajectories, including resolution without transition, or later transition in adulthood, undertaken with much greater stability and decisional capacity."
That is, medicalization is rejected in young people but accepted as a legitimate trajectory in adulthood. This is contradictory with the article's own framework, which criticizes medicalization as a collapse of complexity and as something based on metaphysical beliefs. If these procedures are harmful and based on false premises, they are so both in young people and in adults.
The third is terminological. We must abandon the label of "medicalised" responses. They are procedures to alter phenotypic sexual characteristics; there is no medicine or medicalization there.
And the fourth is that it is time to stop saying that our knowledge is incomplete. Procedures to alter phenotypic sexual characteristics are iatrogenic. They can, in certain cases, provide fleeting and superficial relief, but they do not solve the problems they were supposedly meant to solve. The sentence:
"Ultimately, this debate is not about whether distressed young people deserve our love and support, but whether current practices adequately protect them when our knowledge is incomplete and consequences are lifelong."
Suggests that the problem is a lack of knowledge, when the problem is that we already know enough: these procedures cause harm, and there is no solid evidence that they benefit anyone.
Surely you can have a gendered soul which is manifested in different ways?
I take your point about terminology. I think “gender medicalisation” works as journalistic shorthand. Unlike medicine, medicalisation has a pejorative sense to it, meaning inappropriate use of medical technology & pharmaceuticals.
Bernard, on your first question, I believe yes, one can have a «gendered soul that manifests in different ways». In fact, that is a good way of describing it. The gender we possess is basically something given to us at birth, just like sex. Both sex and gender depend on genes, hormones, and the effects of those genes and hormones on the body (and obviously on the brain, which is part of the body). Gender consists of all those psychological characteristics that «surround» sex. They are like a kind of «helper» to sex.
Sex is the reproductive function; gender is those characteristics that revolve around it. Sexual orientation and all the other masculine or feminine traits emerged evolutionarily as facilitators of reproduction.
While sex is binary, psychological sexual characteristics present themselves along a continuum that has two modes or poles (masculine and feminine), so all of us have a bit of both poles in different combinations. This corresponds to the «gendered soul» in different ways or «flavors», and it also corresponds to being more or less gender conforming and to having a more or less conforming gender identity. They are, at the end of the day, different ways of referring to the gender each of us has.
On terminology, I appreciate your clarification and I understand that «gender medicalisation» works as a shorthand in journalism, and that «medicalisation» has a pejorative connotation referring to the inappropriate use of medical technology and pharmaceuticals. Precisely for that reason, I believe we must be careful: if both promoters and critics designate these procedures as «medicalisation», we are conveying the false idea that they are designed to fix something, to solve something, or to cure something. And at this point in history we already know that these procedures cause harm, because there is a wealth of studies and meta-analyses that have demonstrated it. That is why I propose calling them «procedures to alter phenotypic sexual characteristics», which describes exactly what they do, without presupposing a therapeutic benefit that has not been demonstrated.
It would be interesting to talk to a German about sex & gender because, as I understand it, German has one term which does not distinguish as we do in English.
I like the idea as a helper to sex. It’s often said that sex is real & immutable while gender is wholly socially constructed. Which doesn’t seem right to me. Rather, I think that gender usually operates within limits influenced by sex.
As for terminology, I understand your point. Some use the term “sex-rejecting procedures”. A paediatrician pointed out to me that minors have no endocrine disorder until they are given blockers & hormones. It is only at that point they become “patients” of iatrogenic medicine.
I appreciate the feedback. I will revisit the terminology as soon as I get a chance 🙏
Thanks for sharing