Point being, even the most conservative states haven't (yet) sought to limit treatment for trans adults.[1] Which is not nothing considering how many were so quick to ban abortion.
Also, it's not just the U.S.; plenty of "liberal" Western European countries have reversed course on care for minors. Even the Netherlands, the origin of the WPATH protocol, has pulled back on the reigns for minors, though they haven't yet instituted any prohibitions.
IMO, the trans advocacy rhetoric that equivocated hurdles to gender affirming care for minors as murder backfired. The fact there seems little motivation to limit treatment for adults suggests substantial openness to the issue among even conservative populations. And there are many in the LGTBQ community, include trans community, who share similar sentiments, at least regarding the rhetoric.
[1] Not sure about legislation dictating certain aspects, like waiting periods, but those were widespread as a practical matter in even the most liberal states.
Even with a suppressed puberty, being transgender is extremely hard with high rates of depression and suicide. Any responsible analysis of the aggregate benefits of prescribing blockers needs to factor in the rates of desistence with and without blockers, but proponents of blockers almost always try to frame this discussion as though all kids with gender dysphoria persist in a cross sex gender. And indeed many try to claim that desistence is a "myth", despite most research into the topic.
The DSM criteria for gender dysphoria aren't particularly useful when you are diagnosing kids that play with dolls despite not expressing a trans identity or wish to switch sexes by themselves.
In addition to that, when you are dealing with a conversion therapist it is only natural to depress, but this doesn't mean that it's healthy for you eeither mentally or physically. This is something that was forced onto me as well.
Finally, you seem to be considering transitioning to be inherently something that should be avoided, otherwise why would less kids desisting be considered a negative?
Transition is indeed something that should be avoided if a patient can become comfortable in a same sex gender identity, because even with a suppressed puberty trans people have negative health outcomes across a variety of measures. To say that transition is best avoided if possible isn't a moral judgment against trans people, it's an accurate statement about the disparities in health outcomes.
This is a simplistic model, but imagine trans people have 10% risk of suicide if they don't get blockers, 5% if they do, and cis people have 1%. If I have a cohort of 10 patients with gender dysphoria 8 will desist and 2 will persist without prescribing blockers. And if you do prescribe blockers all of them will persist and transition. The former achieves the optimal health outcomes for the group as a whole. Again this is hugely simplistic, as suicide is not the only healthcare outcome we care about, but it illustrates that desistence rates are relevant to measuring whether blockers improve overall health outcomes.
Of course ideally we'd be able to know which patients will and won't persist. Psychologists attempted to do this for decades, but were never able to reliably predict which patients would and would not persist. People like to point to the extremely low rates of desistence among people prescribed puberty blockers as proof that psychiatrist are predicting correctly. But of course it's also consistent with blockers serving as a determining factor in persistence, and not merely offering "time to think".
Most people who pass by a bus stop don't get on a bus, but if they stop and wait at a bus stop then the probability they soon get on a bus is above 90%. Do you think standing at a bus stop caused them to get on a bus?
It's more like I have two different buses. When kids get on bus A, ~80% of them arrive at destination X and 20% at destination Y. When kids bet on bus B, 2% of them arrive at destination X and 98% of them arrive at destination Y. It sure looks like bus B isn't merely affording the kids "time to think" but is in fact altering their destination, does it not?
The patients in the study are diagnosed with the same criteria for gender dysphoria in the DSM. Heck, the author in the study I linked wrote the criteria for gender dysphoria in the latest iteration of DSM. I'm always puzzled by people who insist that the study was including patients that weren't actually experiencing gender dysphoria.
You say "most research" shows this. From which source(s) do you draw these claims? If I recall correctly there were a lot of methodological issues with drawing this type of conclusion from those studies.
The desistence rate for this study was 87%. Most other studies fall in the range of >70%
> At the time of follow-up, using different metrics (e.g., clinical interview, maternal report, dimensional measurement of gender dysphoria, a DSM diagnosis of GID, etc.), these studies provided information on the percentage of boys who continued to have gender dysphoria (herein termed “persisters”) and the percentage of boys who did not (herein termed “desisters”).2 Of the 53 boys culled from the relatively small sample size studies (Bakwin, Davenport, Kosky, Lebovitz, Money and Russo, Zuger), the percentage classified as persisters was 9.4% (age range at follow-up, 13–30 years). In Green (47), the percentage of persisters was 2% (total n = 44; Mean age at follow-up, 19 years; range, 14–24); in Wallien and Cohen-Kettenis (52), the percentage of persisters was 20.3% (total n = 59; Mean age at follow-up, 19.4 years; range, 16–28); and in Steensma et al. (51), the percentage of persisters was 29.1% (total n = 79; Mean age at follow-up, 16.1 years; range, 15–19). Across all studies, the percentage of persisters was 17.4% (total N = 235), with a range from 0 to 29.1%.3
You can find studies that find a very low rate of desistence, in the single digits. But those are among children that were put on puberty blockers.
Treating people as 'a politically losing issue' is weird to me. There are certainly some nuances to <18 transgender care, but that statement doesn't address any of them and just suggests we embrace political cowardice.
> When policies around it changed, that tipped the scales from the public ignoring trans women or seeing them as victims, towards many members of the public seeing them as monsters who are out to get their children.
This is worse. It wasn't because politics around it changed, it was because republicans (upset that they could no longer target gay people), reused the same crappy arguments against trans people, and then wrapped it in a pedophilic flag.
The change in policy is just effective propaganda making people concerned that random doctors are allowing their children to get sex change operations without consent, when that isn't how ANY of this works. Children <18 can socially transition, get puberty blockers, and MAYBE get hormone treatment. WITH parent consent.
The fact that the media and comments like yours continues to pretend its a reasonable 'discussion' perpetuates the nonsense.
Imagine trying to make the same argument about forcing cis women to go through male liberty to "understand men better". It's ridiculous.
Further, studies show that the main predictor of bone structure is whether you started HRT before or after the beginning of puberty, and that outcomes get worse the more it progresses. At 18 you still get some change, but you really need to either block puberty or start HRT before it for optimal outcomes.
And if you don't want to give HRT to trans children, at least get them on puberty blockers. There's pretty much zero evidence suggesting they do anything worse than temporary and reversible reductions in bone density.
The effects are only partially reversible, and only after tens or hundreds of thousands of dollars in surgeries, hair removal, voice training, other treatments.
I understand it's a politically losing issue now, but I believe it's due to misinformation, outrage porn, and unfair application of rigor, from mostly the anti-trans side but even allies and trans folk themselves sometimes. To that end I hope this does not feel like an attack - let me know if you have any questions that you think my perspective would help.
This is the key point, imho.
In the transgender rights discourse no margin for error is admitted, but there is like in any other human field (of course).
There have been several cases of people being given a "gender disphoria" blanket diagnosis (eg: the case of Chlementine Breen[1]), which later caused issues. And of course some of those people are transitioning back and started doing activism against the trans rights movement.
It's weird that minors are not allowed to do something trivial as drinking a beer or driving a car yet they're allowed to take on irreversible changes (sometimes involving surgery) to their bodies.
This is hurtful to all people involved, and until this point is not understood, the attrition will continue.
[1]: that case is a textbook example of "no margin error admitted" because in order for their voice to be heard they had to resort to talking to the extreme opposite political side.
The wrong puberty is irreversible mutilation. It's not weird at all given that kids are being given treatment for cancer.
Damn the social consequences, it's who we are. If transitioning were available as a minor it would greatly reduce suffering.
Don't get me wrong, trans issues do need more study, but this is also an example of isolated demand for rigor. Why the undue focus and criticism of trans healthcare over treatment of other rare medical conditions, which also tend to lack RCTs?
In addition, trans healthcare in Sweden has historically been behind the US. Trans people were forcibly sterilized up until 2013, and trans healthcare underfunded. In Finland the sterilization was required until 2023!
The UK, Italy, Denmark, and Sweden all stopped prescribing puberty blockers to gender dysphoric children following the Cass review. Other countries, like Finland, has stopped earlier. It's not possible to continue insisting that this is settled science, when much of the developed world has broken with the US's approach towards gender care in minors.
> Why the undue focus and criticism of trans healthcare over treatment of other rare medical conditions, which also tend to lack RCTs?
Such as? Furthermore, there were RCTs conducted studying the effects of puberty blockers. They didn't decrease gender dysphoria.
Also, put the evidence (or lack thereof) in the context of the certainty and urgency that proponents of gender medicalization were conveying: People were claiming that gender dysphoric children were going to kill themselves if they don't get blockers. Doctors like Joanna Olson-Kennedy repeatedly claimed that parents had the choice of a dead son or alive daughter, a statement parroted by politicians.
This was all total BS. That very same doctor sat on data showing zero improvement with puberty blockers [1]. And now she's trying to argue that no benefit is actually a good result because the patients would have fared even worse absent blockers. But of course, without a control group there's no substance to that claim.
1. https://www.nytimes.com/2024/10/23/science/puberty-blockers-...
Here's a study showing evidence that gender dysphoria treatment in children improves well-being and mental health: https://pubmed.ncbi.nlm.nih.gov/25201798/
There's loads more.
Neither the discussion nor the conclusion mention this, so maybe I'm misinterpreting something?
Yes, we're at a juncture. But my point is I don't think bans for adult care are inevitable, nor that strict prohibitions for minors need be permanent. If trans advocates and their supports took a breather and figured out how to reframe things, the backslide (such as it is) could be arrested and even reversed. But that will require, at a minimum, taking back the microphone from the most radical "advocates". And probably to depoliticize it. The issue has become highly politically polarized, but that's a relatively recent thing. I was gobsmacked by the generally tame and sympathetic conservative response to Caitlyn Jenner among conservatives 10 years ago. The turn was avoidable and, arguably, reversible.
I agree with your assessment, and I am suspicious of anyone (on either side) who claims that there is an obvious “correct” answer to this issue.
It's the same medicine from the same medical professionals and the only difference is your gender identity.
https://www.npr.org/2025/06/18/nx-s1-5421276/scotus-transgen...
At the national level, The One Big Beautiful Bill Act as passed by the House cuts all federal funding for transgender care for adults via Medicaid [3], though that's still pending what the Senate does.
[1] https://apnews.com/article/florida-transgender-health-care-a...
[2] https://www.pbs.org/newshour/health/missouri-governor-signs-...
[3] https://www.politifact.com/article/2025/jun/02/medicaid-bill...
Given that a number have prohibited it from being paid for by the state Medicaid program for adults when it previously was, that is, maybe, a glass quarter full take. (There is also the issue that wrong-gender puberty is a particularly significant suicide risk factor for trans youth, so restricting gender affirming care for youth is a particularly strong assault on trans lives.)
And even then, its not strictly true, as while most states with restrictions that have passed have only restricted care to minors, Nebraska did so for persons under the age of 19, which includes some adults.
> Point being, even the most conservative states haven't (yet) sought to limit treatment for trans adults.
They have not only sought to do so, they have actually done so (as mentioned above). They have not yet implemented broad prohibitions (except Nebraska's for adults under 19), but "limit" and "broad prohibition" are not the same thing, and mere limitations can have the same practical effect as broad prohibitions, as many states demonstrated by making it nearly a practical impossibility to provide (and therefore access) abortion services, even before the Supreme Court overturned Roe; conservative states are following the same playbook with gender-affirming care.
> Not sure about legislation dictating certain aspects, like waiting periods, but those were widespread as a practical matter in even the most liberal states.
No, legally-imposed waiting periods for adult (or even youth) gender affirming care were not present (and still are not present) in the most liberal states. That's a very strange thing to invent to minimize the restrictions being imposed by conservative states.
If you are equating the fact that it can take time, for some services beyond HRT, to save up money and/or jump through whatever hoops are established by your insurance, and find and schedule time with the required provider(s) with legislatively imposed waiting periods and other access restrictions, that's incredibly dishonest (for one thing, the legislative restrictions don't overlap the other ones, they add on top, and, by making it more difficult for providers to operate and thereby reducing the number of providers, make the other issues worse as well.)
Technically, most countries don’t allow people to be openly gay. In some countries, being gay even privately means you get beaten to death or your head chopped off.
Needless to say that transgender people are not even taken into consideration.
If I was gay or transgender, god knows I would rather be in the USA or maybe north Europe than any other country and especially not Africa, Arabia, South America.
So to recap, you're saying, "don't worry about what's going on in the US right now, because you still have it better than most of the world"
Just because something could be worse does not mean that 1. It's nothing to be concerned about 2. That we shouldn't take steps to improve the situation.
Things can always be worse, so this "logic" is always applicable. It's a vacuous argument. Even if you lived in the country with the worst homo/transphobia in the world, you could tell the person, "well, at least your alive."
Moreover, there's nothing constructive about this line of thinking. If people actually lived by this logic, we would live in a static world, because "it could be worse."
> The Legal Medicine Organization performs a number of tests, including at least six months of individual and group therapy sessions, interviews with family members, physical examinations, hormone tests, and chromosomal tests, in a process known as "filtering". Filtering is the separation of homosexuals, who are deemed "deviant", from transsexuals, who are deemed "curable" by undergoing surgery
Also, after further research, Iran is the only Muslim country in the Persian Gulf region that gives trans citizens the right to have their gender identity recognized by the law.
I don’t understand how such a country can be so open on trans right, but it’s really an exception in the world.